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Li C, Zhou W, Wang P, Ji P, Wang Y, Guo S, Zhai Y, Xu M, Wang L, Feng F, Liu J. Prognostic Factors for Patients with Primary Gliosarcoma: A Single-Center Retrospective Study. World Neurosurg 2024:S1878-8750(24)01497-9. [PMID: 39216722 DOI: 10.1016/j.wneu.2024.08.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/23/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Primary gliosarcoma is a rare form of malignant central nervous system tumor, with limited understanding regarding its prognostic determinants and effective therapeutic interventions. METHODS The medical records of patients diagnosed with gliosarcoma at Tangdu Hospital between March 2011 and June 2023 were retrospectively analyzed in this study. Patients with a prior history of glioma or those who received preoperative chemoradiotherapy were excluded. Survival analyses were conducted using Kaplan-Meier and Cox regression analysis. RESULTS A total of 77 patients were included in the final analysis, with a median age of 57 years (range: 13-83). The predominant symptom leading to diagnosis was headache, and the temporal lobe was the most frequently affected site. Univariate analysis revealed that age ≤65 years, complete resection, Ki67 ≤ 25%, postoperative Karnofsky Performance Status ≥ 70, adherence to the Stupp protocol, and additional active therapy upon relapse were associated with enhanced survival. Furthermore, multivariate analysis identified complete resection, age ≤65 years, Stupp protocol treatment, and active therapy following relapse were independent predictors of overall survival. Notably, 1 patient experienced subcutaneous metastasis during treatment. CONCLUSIONS The present study's findings suggest that optimal management of primary gliosarcoma entails maximal safe resection, combined with adjuvant radiotherapy and chemotherapy with temozolomide, followed by salvage therapy in case of recurrence. However, the risk of metastases should be carefully monitored during the treatment course.
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Affiliation(s)
- Chen Li
- Department of Neurosurgery, The Second Affiliated Hospita of Air Force Medical University, Xian, China
| | - Wenqian Zhou
- The Fourth Student Brigade of Basic Medical College, Air Force Medical University, Xian, China
| | - Peng Wang
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peigang Ji
- Department of Neurosurgery, The Second Affiliated Hospita of Air Force Medical University, Xian, China
| | - Yuan Wang
- Department of Neurosurgery, The Second Affiliated Hospita of Air Force Medical University, Xian, China
| | - Shaochun Guo
- Department of Neurosurgery, The Second Affiliated Hospita of Air Force Medical University, Xian, China
| | - Yulong Zhai
- Department of Neurosurgery, The Second Affiliated Hospita of Air Force Medical University, Xian, China
| | - Meng Xu
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Liang Wang
- Department of Neurosurgery, The Second Affiliated Hospita of Air Force Medical University, Xian, China
| | - Fuqiang Feng
- Department of Neurosurgery, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Jinghui Liu
- Department of Neurosurgery, The Second Affiliated Hospita of Air Force Medical University, Xian, China.
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Johnson M, Bell A, Lauing KL, Ladomersky E, Zhai L, Penco-Campillo M, Shah Y, Mauer E, Xiu J, Nicolaides T, Drumm M, McCortney K, Elemento O, Kim M, Bommi P, Low JT, Memon R, Wu J, Zhao J, Mi X, Glantz MJ, Sengupta S, Castro B, Yamini B, Horbinski C, Baker DJ, Walunas TL, Schiltz GE, Lukas RV, Wainwright DA. Advanced Age in Humans and Mouse Models of Glioblastoma Show Decreased Survival from Extratumoral Influence. Clin Cancer Res 2023; 29:4973-4989. [PMID: 37725593 PMCID: PMC10690140 DOI: 10.1158/1078-0432.ccr-23-0834] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/03/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Glioblastoma (GBM) is the most common aggressive primary malignant brain tumor in adults with a median age of onset of 68 to 70 years old. Although advanced age is often associated with poorer GBM patient survival, the predominant source(s) of maladaptive aging effects remains to be established. Here, we studied intratumoral and extratumoral relationships between adult patients with GBM and mice with brain tumors across the lifespan. EXPERIMENTAL DESIGN Electronic health records at Northwestern Medicine and the NCI SEER databases were evaluated for GBM patient age and overall survival. The commercial Tempus and Caris databases, as well as The Cancer Genome Atlas were profiled for gene expression, DNA methylation, and mutational changes with varying GBM patient age. In addition, gene expression analysis was performed on the extratumoral brain of younger and older adult mice with or without a brain tumor. The survival of young and old wild-type or transgenic (INK-ATTAC) mice with a brain tumor was evaluated after treatment with or without senolytics and/or immunotherapy. RESULTS Human patients with GBM ≥65 years of age had a significantly decreased survival compared with their younger counterparts. While the intra-GBM molecular profiles were similar between younger and older patients with GBM, non-tumor brain tissue had a significantly different gene expression profile between young and old mice with a brain tumor and the eradication of senescent cells improved immunotherapy-dependent survival of old but not young mice. CONCLUSIONS This work suggests a potential benefit for combining senolytics with immunotherapy in older patients with GBM.
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Affiliation(s)
- Margaret Johnson
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - April Bell
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Kristen L. Lauing
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
- Department of Neurological Surgery at Loyola University Medical Center, Maywood, Illinois
| | | | - Lijie Zhai
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
- Department of Neurological Surgery at Loyola University Medical Center, Maywood, Illinois
| | - Manon Penco-Campillo
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
- Department of Neurological Surgery at Loyola University Medical Center, Maywood, Illinois
| | - Yajas Shah
- Institute of Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | | | | | | | - Michael Drumm
- Department of Neurological Surgery, Feinberg School of Medicine, Chicago, Illinois
| | - Kathleen McCortney
- Department of Neurological Surgery, Feinberg School of Medicine, Chicago, Illinois
| | - Olivier Elemento
- Institute of Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Miri Kim
- Department of Neurological Surgery at Loyola University Medical Center, Maywood, Illinois
| | - Prashant Bommi
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
- Department of Neurological Surgery at Loyola University Medical Center, Maywood, Illinois
| | - Justin T. Low
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Ruba Memon
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Jennifer Wu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Junfei Zhao
- Department of Systems Biology, Herbert Irving Comprehensive Center, Columbia University, New York, New York
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Xinlei Mi
- Department of Preventive Medicine-Division of Biostatistics at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael J. Glantz
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Soma Sengupta
- Departments of Neurology, Neurosurgery, and the Lineberger Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Brandyn Castro
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois
| | - Bakhtiar Yamini
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois
| | - Craig Horbinski
- Department of Neurological Surgery, Feinberg School of Medicine, Chicago, Illinois
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Darren J. Baker
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
- Paul F. Glenn Center for the Biology of Aging at Mayo Clinic, Rochester, Minnesota
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | - Theresa L. Walunas
- Department of Medicine-Division of General Internal Medicine and Geriatrics at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gary E. Schiltz
- Department of Chemistry, Northwestern University, Evanston, Illinois
| | - Rimas V. Lukas
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Derek A. Wainwright
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
- Department of Neurological Surgery at Loyola University Medical Center, Maywood, Illinois
- Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois
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Elserius ASL, Hodson J, Zisakis A, Ughratdar I. Is there a limited value of cytoreductive surgery in elderly patients with malignant gliomas? Surg Neurol Int 2022; 13:320. [PMID: 35928314 PMCID: PMC9345099 DOI: 10.25259/sni_438_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Glioblastoma (GB) is well known for being the most aggressive primary cerebral malignancy. The peak incidence is at 60–70 years of age, with over half of patients aged over 65 years at diagnosis. Methods: Patients with a confirmed histological diagnosis of GB between January 2009 and June 2016 at a single center were retrospectively identified. The inclusion criteria for the study were age over 65 years at diagnosis, and surgical management with either a burr hole biopsy or craniotomy. Results: A total of n = 289 patients underwent surgery for GB, with a median age at diagnosis of 71 years, and of whom 64% were male. Craniotomies were performed in 71%, with burr hole biopsies performed in the remainder (29%). Patient survival differed significantly with treatment modality (P < 0.001), ranging from a median of 382 days in those treated with a combination of craniotomy, radiotherapy (RT), and temozolomide (TZM), to 43 days in those only receiving a burr hole biopsy with no further treatment. On multivariable analysis, treatment with RT + TZM was significantly independently associated with longer patient survival (P < 0.001). Craniotomy was associated with a significant improvement in performance status, compared to burr hole biopsy (P = 0.006). For the subgroup of patients receiving TZM, those with a methylated O6-methylguanine-DNA-methyltransferase (MGMT) status had significantly longer overall survival than those with unmethylated MGMT (median: 407 vs. 341 days, P = 0.039). Conclusion: Our retrospective data demonstrate that the elderly population with GB benefit from aggressive chemo-RT, regardless of surgical intervention.
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Affiliation(s)
- Anne S. L. Elserius
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - James Hodson
- Institute of Translational Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Athanasios Zisakis
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Ismail Ughratdar
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
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Morshed RA, Young JS, Casey M, Wang EJ, Aghi MK, Berger MS, Hervey-Jumper SL. Sarcopenia Diagnosed Using Masseter Muscle Diameter as a Survival Correlate in Elderly Patients with Glioblastoma. World Neurosurg 2022; 161:e448-e463. [PMID: 35181534 PMCID: PMC9284942 DOI: 10.1016/j.wneu.2022.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Elderly patients with glioblastoma (GBM) have a worse prognosis than do younger patients. The present study aimed to identify the patient, treatment, and imaging features, including measures of sarcopenia, associated with worse survival and 90-day postoperative mortality for elderly patients with GBM. METHODS A single-center retrospective study was conducted of patients aged ≥79 years at surgery who had undergone biopsy or resection of a World Health Organization grade IV GBM at the initial diagnosis. Imaging features of sarcopenia were collected, including the masseter and temporalis muscle diameters. Multivariate analyses were performed to identify factors associated with survival and 30-day complications. RESULTS The cohort included 110 patients with a mean age of 82.8 years at surgery and a median preoperative Karnofsky performance scale score of 80. The majority of patients underwent a surgical resection (66.4%) while a minority underwent biopsy (33.6%). Adjuvant chemo- and/or radiation therapy were used in 72.5% of the cohort. On multivariate analysis, age (hazard ratio [HR], 7.97; 95% confidence interval [CI], 1.63-36.3), adjuvant therapy (RT or TMZ vs. none: HR, 0.12; 95% CI, 0.05-0.3; RT plus TMZ vs. none: HR, 0.05; 95% CI, 0.02-0.14), surgical resection (HR, 0.46; 95% CI, 0.24-0.9), multifocality (HR, 2.7; 95% CI, 1.14-6.4), and masseter diameter (HR, 0.12; 95% CI, 0.02-0.78) were associated with survival. Masseter diameter was the only factor associated with 90-day mortality after surgical resection (P = 0.044). CONCLUSIONS GBM patients over the age of 79 have acceptable outcomes after resection, followed by adjuvant chemotherapy and RT. In addition to the treatment factors that predicted for survival, a decreased masseter diameter on preoperative imaging, a marker of sarcopenia, was associated with shorter overall survival and 90-day mortality after surgical resection.
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Affiliation(s)
- Ramin A Morshed
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jacob S Young
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Megan Casey
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Elaina J Wang
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Manish K Aghi
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
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5
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Palliative care of older glioblastoma patients in neurosurgery. J Neurooncol 2022; 157:297-305. [PMID: 35332410 PMCID: PMC9021091 DOI: 10.1007/s11060-022-03985-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/14/2022] [Indexed: 11/17/2022]
Abstract
Purpose The care of older neurosurgical patients at the end life is a particularly demanding challenge. Especially, the specific needs of very old patients with glioblastoma at the end of life are at risk of being deprived of adequate care. Methods Based on a narrative literature review, this article aims to explore key issues of the thematic intersection of geriatric glioblastoma patients, palliative care and neurosurgery. Results and discussion Four key issues were identified: patient-centeredness (need orientation and decision making), early palliative care, advance care planning, and multi-professionalism. Possible benefits and barriers are highlighted with regard to integrating these concepts into neurosurgery. Conclusions Palliative care complements neurosurgical care of geriatric glioblastoma multiforme patients to optimise care for this highly vulnerable category of patients.
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Liu J, Li C, Wang Y, Ji P, Guo S, Zhai Y, Wang N, Lou M, Xu M, Chao M, Jiao Y, Zhao W, Feng F, Qu Y, Ge S, Wang L. Prognostic and Predictive Factors in Elderly Patients With Glioblastoma: A Single-Center Retrospective Study. Front Aging Neurosci 2022; 13:777962. [PMID: 35173600 PMCID: PMC8841486 DOI: 10.3389/fnagi.2021.777962] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Glioblastoma (GBM) is the most common primary malignant intracranial tumor and the median age at diagnosis is 65 years. However, elderly patients are usually excluded from clinical studies and age is considered as an independent negative prognostic factor for patients with GBM. Therefore, the best treatment method for GBM in elderly patients has remained controversial. Elderly GBM patients (≥ 60 years old) treated between January 2015 and December 2019 were enrolled in this study. Medical records were reviewed retrospectively, and clinicopathological characteristics, treatments, and outcomes were analyzed. A total of 68 patients were included, with a median age of 65.5 years (range: 60–79). The median preoperative Karnofsky performance scale (KPS) score was 90 (range 40–100) and median postoperative KPS score was 80 (range 0–90). Univariate analysis results showed that age, gender, comorbidities, preoperative KPS < 90 and MGMT promoter methylation were not significantly associated with PFS and OS. On the other hand, total resection, postoperative KPS ≥ 80, Ki67 > 25%, and Stupp-protocol treatment were significantly associated with prolonged PFS and OS. Moreover, multivariate analysis found that postoperative KPS ≥ 80, total resection, and Stupp-protocol treatment were prognostic factors for PFS and OS. The findings of this study have suggested that, on the premise of protecting function as much as possible, the more aggressive treatment regimens may prolong survival for elderly patients with GBM. However, further studies, particularly prospective randomized clinical trials, should be conducted to provide more definitive data on the appropriate management of elderly patients, especially for patients with MGMT promoter methylation.
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Affiliation(s)
- Jinghui Liu
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Chen Li
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yuan Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Peigang Ji
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Shaochun Guo
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yulong Zhai
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Na Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Miao Lou
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Meng Xu
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Min Chao
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yang Jiao
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Wenjian Zhao
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Fuqiang Feng
- Department of Neurosurgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Shunnan Ge
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
- *Correspondence: Shunnan Ge,
| | - Liang Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
- Liang Wang,
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Bjorland LS, Fluge O, Gilje B, Mahesparan R, Farbu E. Treatment approach and survival from glioblastoma: results from a population-based retrospective cohort study from Western Norway. BMJ Open 2021; 11:e043208. [PMID: 33712524 PMCID: PMC7959220 DOI: 10.1136/bmjopen-2020-043208] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To evaluate treatment and survival from glioblastoma in a real-world setting. DESIGN AND SETTINGS A population-based retrospective cohort study from Western Norway. PARTICIPANTS 363 patients aged 18 years or older diagnosed with glioblastoma between 1 January 2007 and 31 December 2014. PRIMARY AND SECONDARY OUTCOME MEASURES Overall survival and survival rates determined by Kaplan-Meier method, groups compared by log-rank test. Associations between clinical characteristics and treatment approach assessed by logistic regression. Associations between treatment approach and outcome analysed by Cox regression. RESULTS Median overall survival was 10.2 months (95% CI 9.1 to 11.3). Resection was performed in 221 patients (60.9%), and was inversely associated with age over 70 years, higher comorbidity burden, deep-seated tumour localisation and multifocality. Median survival was 13.7 months (95% CI 12.1 to 15.4) in patients undergoing tumour resection, 8.3 months (95% CI 6.6 to 9.9) in patients undergoing biopsy and 4.5 months (95% CI 4.0 to 5.1) in patients where no surgical intervention was performed. Chemoradiotherapy according to the Stupp protocol was given to 157 patients (43%). Age over 70 years, higher comorbidity burden and cognitive impairment were associated with less intensive chemoradiotherapy. Median survival was 16.3 months (95% CI 14.1 to 18.5), 7.9 months (95% CI 6.7 to 9.0) and 2.0 months (95% CI 0.9 to 3.2) in patients treated according to the Stupp protocol, with less intensive chemoradiotherapy and with best supportive care, respectively. Surgical resection (HR 0.61 (95% CI 0.47 to 0.79)) and chemoradiotherapy according to the Stupp protocol (HR 0.09 (95% CI 0.06 to 0.15)) were strongly associated with favourable overall survival, when adjusted for clinical variables. CONCLUSIONS In a real-world setting, less than half of the patients received full-course chemoradiotherapy, with a median survival comparable to results from clinical trials. Survival was considerably worse in patients receiving less intensive treatment. Our results point out a substantial risk of undertreating glioblastoma, especially in elderly patients.
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Affiliation(s)
- Line Sagerup Bjorland
- Department of Clinical Medicine, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
- Department of Haematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Oystein Fluge
- Department of Oncology and Medical Physics, Haukeland Universitetssjukehus, Bergen, Norway
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Bjornar Gilje
- Department of Haematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Rupavathana Mahesparan
- Department of Clinical Medicine, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Elisabeth Farbu
- Department of Clinical Medicine, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
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8
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Chandra A, Lopez-Rivera V, Dono A, Brandel MG, Lewis C, O'Connor KP, Sheth SA, Ballester LY, Aghi MK, Esquenazi Y. Comparative Analysis of Survival Outcomes and Prognostic Factors of Supratentorial versus Cerebellar Glioblastoma in the Elderly: Does Location Really Matter? World Neurosurg 2020; 146:e755-e767. [PMID: 33171326 DOI: 10.1016/j.wneu.2020.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cerebellar glioblastomas (cGBMs) are rare tumors that are uncommon in the elderly. In this study, we compare survival outcomes and identify prognostic factors of cGBM compared with the supratentorial (stGBM) counterpart in the elderly. METHODS Data from the SEER 18 registries were used to identify patients with a glioblastoma (GBM) diagnosis between 2000 and 2016. The log-rank method and a multivariable Cox proportional hazards regression model were used for analysis. RESULTS Among 110 elderly patients with cGBM, the median age was 74 years (interquartile range [IQR], 69-79 years), 39% were female and 83% were white. Of these patients, 32% underwent gross total resection, 73% radiotherapy, and 39% chemotherapy. Multivariable analysis of the unmatched and matched cohort showed that tumor location was not associated with survival; in the unmatched cohort, insurance status (hazard ratio [HR], 0.11; IQR, 0.02-0.49; P = 0.004), gross total resection (HR, 0.53; IQR, 0.30-0.91; P = 0.022), and radiotherapy (HR, 0.33; IQR, 0.18-0.61; P < 0.0001) were associated with better survival. Patients with cGBM and stGBM undergoing radiotherapy (7 months vs. 2 months; P < 0.001) and chemotherapy (10 months vs. 3 months; P < 0.0001) had improved survival. Long-term mortality was lower for cGBM in the elderly at 24 months compared with the stGBM cohort (P = 0.007). CONCLUSIONS In our study, elderly patients with cGBM and stGBM have similar outcomes in overall survival, and those undergoing maximal resection with adjuvant therapies, independent of tumor location, have improved outcomes. Thus, aggressive treatment should be encouraged for cGBM in geriatric patients to confer the same survival benefits seen in stGBM. Single-institutional and multi-institutional studies to identify patient-level prognostic factors are warranted to triage the best surgical candidates.
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Affiliation(s)
- Ankush Chandra
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA; Department of Neurosurgery, Memorial Hermann Hospital-TMC, Houston, Texas, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Victor Lopez-Rivera
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Antonio Dono
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA; Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael G Brandel
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA
| | - Cole Lewis
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA; Department of Neurosurgery, Memorial Hermann Hospital-TMC, Houston, Texas, USA
| | - Kyle P O'Connor
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA; Department of Neurosurgery, Memorial Hermann Hospital-TMC, Houston, Texas, USA
| | - Sunil A Sheth
- Department of Neurosurgery, Memorial Hermann Hospital-TMC, Houston, Texas, USA; Department of Neurology, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Leomar Y Ballester
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA; Department of Neurosurgery, Memorial Hermann Hospital-TMC, Houston, Texas, USA; Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Manish K Aghi
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Yoshua Esquenazi
- Department of Neurosurgery, Memorial Hermann Hospital-TMC, Houston, Texas, USA; Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA; Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
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9
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Health-related quality of life and emotional well-being in patients with glioblastoma and their relatives. J Neurooncol 2020; 149:347-356. [PMID: 32909116 PMCID: PMC7541353 DOI: 10.1007/s11060-020-03614-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE The health-related quality of life (HRQoL) for patients with glioblastoma is known to be largely affected. Little is known about the HRQoL for relatives and the relationship between these two. To optimize family care, such issues need to be addressed early on, preferably from the time of diagnosis. This study aimed to describe and compare the HRQoL of patients with glioblastoma and their relatives before surgery. METHODS A prospective cohort study including 89 patients diagnosed with glioblastoma and their relatives. HRQoL (Short Form Health Survey, SF-36) and emotional well-being (hospital anxiety and depression scale, HADS) were analysed with descriptive, comparative and multivariable regression analyses. RESULTS Relatives scored worse for mental HRQoL (p < 0.001) and for symptoms of anxiety (p < 0.001) and depression (p = 0.022) compared to patients. The multivariable regression showed an increased risk of affected mental HRQoL in relatives of patients with poor functional status (WHO) (p = 0.01) and higher levels in symptoms of anxiety (p = 0.03), or when relatives had low physical HRQoL themselves (p = 0.01). There was increased risk of affected mental HRQoL in patients with comorbidities (p = 0.003), and when the respective relative showed higher levels in symptoms of anxiety (p = 0.005). CONCLUSION Relatives scored worse for mental HRQoL and emotional well-being than patients, suggesting that HRQoL in patients and relatives might be connected to symptoms of anxiety in the respective individual at disease onset. The results illustrate the need to screen HRQoL and emotional well-being in both patients and relatives from an early stage-before surgery.
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Lütgendorf-Caucig C, Freyschlag C, Masel EK, Marosi C. Guiding Treatment Choices for Elderly Patients with Glioblastoma by a Comprehensive Geriatric Assessment. Curr Oncol Rep 2020; 22:93. [PMID: 32651730 PMCID: PMC7351817 DOI: 10.1007/s11912-020-00951-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The incidence of glioblastoma multiforme (GBM) increases with age; more than half of newly diagnosed patients are older than 65 years. Due to age-dependent decreasing organ functions, comorbidities, functional decline, and increasing risk of social isolation, not all patients are able to tolerate standard therapy of GBM with 6 weeks of radiochemotherapy. RECENT FINDINGS A set of alleviated therapies, e.g., chemotherapy or radiotherapy alone, hypofractionated radiotherapies with different total doses and variable fractionation regimens as well as hypofractionated radiotherapy with concomitant and adjuvant chemotherapy, have been evaluated during the last years. However, clinicians are still unsure which therapy would fit best to a given patient. Recently, the predictive value of comprehensive geriatric assessment regarding tolerance of chemotherapy and prediction of early mortality has been validated for older GBM patients in a retrospective trial. Thus, it appears that neuro-oncology is now ready for the prospective implementation of geriatric assessment to guide treatment planning for elderly GBM patients.
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Affiliation(s)
| | | | - Eva Katharina Masel
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christine Marosi
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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