Management considerations for very elderly patients with intracranial low-grade gliomas: A surveillance,...

Management of intracranial low-grade gliomas (LGG) in the very elderly (≥85 years) remains poorly characterized as most studies classify "elderly" patients broadly as ≥ 65 years, which obscures age-specific risks and outcomes among the oldest-old. In this study, we evaluated treatment patterns and survival predictors in very elderly patients with LGG using a large population-based cohort registry.

Patients aged ≥ 75 years with histologically confirmed intracranial LGG were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2022). Cases were stratified into elderly (75-84 years) and very elderly (≥85 years) cohorts. Multivariable Cox proportional hazards models were used to identify predictors of overall survival (OS), and hazard ratios (HRs) and 95% confidence intervals (CIs) were reported.

A total of 1124 patients met inclusion criteria, including 942 aged 75-84 and 182 aged ≥ 85 years. In the ≥ 85-year cohort (the primary cohort of interest), both subtotal resection (HR: 0.628; 95% CI: 0.416-0.949; p = 0.027) and gross total resection (HR: 0.543; 95% CI: 0.311-0.950; p = 0.033) were independently associated with improved survival. No significant associations were observed for chemotherapy or radiotherapy, though neither demonstrated harm. In the 75-84 year comparison cohort, subtotal resection (HR: 0.731; p < 0.001), gross total resection (HR: 0.684; p < 0.001), and chemotherapy (HR: 0.799; p = 0.014) predicted longer OS.

Surgical resection remains a significant predictor of improved survival even among patients aged ≥ 85 years, which suggests that carefully selected very elderly patients can benefit from operative management, and surgical management should not be precluded based on age alone. Chemotherapy and radiotherapy effects appeared inconclusive in the very elderly but not detrimental. Future studies integrating molecular and quality-of-life data are needed to refine management strategies in this uniquely vulnerable population.