Surgery for high-grade gliomas in the aging.

Area of Science:

• Neurosurgery
• Oncology
• Geriatric Medicine

Background:

• High-grade glioma (HGG) is the most frequent primary brain tumor in adults.
• Older patients (≥ 60 years) represent a significant and growing population diagnosed with HGG.
• Optimal management strategies for HGG in this demographic require careful consideration of surgical risks and treatment efficacy.

Purpose of the Study:

• To prospectively evaluate the outcomes of surgical intervention and adjuvant therapy for high-grade gliomas (HGG) in patients aged 60 years and older.
• To assess surgical mortality and morbidity in this patient cohort.
• To identify factors influencing overall survival following treatment for HGG in older adults.

Main Methods:

• A prospective study included 80 patients aged ≥ 60 years undergoing craniotomy for WHO grade 3 and 4 gliomas between 2008-2009.
• Outcomes were assessed at six months post-surgery, with overall mortality evaluated at two years.
• Survival analyses considered patient age, extent of tumor resection, American Society of Anesthesiology (ASA) scores, Karnofsky performance scale (KPS), and mini-mental state examination (MMSE) scores.

Main Results:

• Surgical mortality was low at 1.3%, with morbidities including neurological sequelae (10%), post-operative hematomas (3.8%), and hydrocephalus (1.3%).
• Median overall survival was 8.4 months, significantly improved by adjuvant radiochemotherapy.
• Factors significantly reducing survival included age ≥ 80 years, subtotal resection, ASA scores 3-4, KPS < 70, and MMSE score < 25.

Conclusions:

• Surgical treatment for HGG in patients ≥ 60 years demonstrates low mortality and manageable morbidity.
• Adjuvant bimodal treatment (radiochemotherapy) is associated with improved survival outcomes.
• Maximum safe tumor resection should be pursued, while treatment benefits may be limited in patients aged ≥ 80 years or those with significant pre-operative functional deficits.