Gross-total resection of malignant gliomas in elderly patients: Implications in survival

Background: Malignant gliomas in elderly patients are frequently under represented in neuro-oncology trials because of presumed low tolerability of gross-total resection and radiochemotherapy treatments. Thus, the balance of benefit versus adverse response of standard glioma therapy remains controversial. We hypothesized that older patients with malignant gliomas might also take advantage of extensive surgical procedures. Patients and Methods: We analyzed retrospectively 138 consecutive malignant glioma patients. Sixty-two patients were > 65 years whereas seventy-six were <= 65 years. Evaluation consists of clinical features at diagnosis, neurological functional status, surgical procedures, post-operative complications and the predictive value of the former variables for survival. Results: At diagnosis, elderly patients showed a larger burden of comorbidities but they did not influence outcome significantly. Gross-total resection was associated with a longer survival as compared to biopsy and subtotal resection in both groups of elderly (p=0.05 and 0.001, respectively) and younger patients (p = 0.004 and 0.003). Concerning complications, the only difference between both collectives was a higher incidence of psychosyndrome in the elderly group (p = 0.016). Conclusions: Our results indicate that gross-total resection of malignant gliomas in elderly patients is associated with a survival benefit without increased morbidity.