Survival and function in elderly patients with GBM: the role of surgical resection with contemporary multimodal therapy

PURPOSE: Is surgical resection associated with better overall survival and preserved functional outcomes in elderly patients with GBM compared to biopsy alone in a single-institution with homogeneous clinical protocols? METHODS: We conducted a single-surgeon, single-center retrospective cohort study of patients aged ≥ 70 years treated between 2016 and 2024 to compare survival following resection versus biopsy for lobar GBM. RESULTS: Among 82 patients, 65 (79.3%) underwent resection and 17 (20.7%) biopsy. Median survival was significantly longer after resection than biopsy (8.8 vs. 2.7 months). On multivariate Cox analysis adjusting for radiation, temozolomide, MGMT status, and ASA score, resection remained associated with improved survival (HR = 0.34, 95% CI = 0.19–0.63, p < 0.001). The survival benefit persisted in both MGMT-methylated and unmethylated tumors but was observed only among patients receiving adjuvant therapy. In octogenarians, resection was independently associated with improved survival (HR = 0.28, 95% CI = 0.10–0.81, p = 0.018), with greatest benefit in MGMT-methylated tumors and those treated with temozolomide. Among patients alive with recorded ECOG assessments, 63.6%, 69.2%, and 70.8% had ECOG < 2 at 3, 6, and 12 months, respectively. Nine patients (11%) survived beyond two years; all achieved gross total resection, had MGMT-methylated tumors, and completed full adjuvant therapy. CONCLUSIONS: By applying uniform clinical protocols, these findings support consideration of maximal safe resection in carefully selected elderly GBM patients when combined with multimodal treatment. Given the retrospective design and limited subgroup sizes, however, these findings should be considered exploratory and warrant validation in larger cohorts.