Elderly patients aged over 75 years with glioblastoma: Preoperative status and surgical strategies

Background: Standards of care for the elderly with glioblastoma are still unknown, because most studies exclude elderly patients. The effects of preoperative status and surgical strategies on the prognosis for elderly glioblastoma patients were studied. Methods: We defined "elderly" as 75 years or older and retrospectively reviewed 137 patients with glioblastoma, including 31 (22.6%) elderly patients. Relationships between age and clinicopathological variables were investigated. Results: The median overall survival (OS) was 15.8 months in the nonelderly group and 10.8 months in the elderly group (p = 0.02). The median progression-free survival (PFS) was 9.1 months in the nonelderly group and 6.6 months in the elderly group (p = 0.02). Median OS and median PFS had no relationship between low (<70) and high (>= 70) Karnofsky performance status (KPS) in the nonelderly group. However, the median OS was significantly longer in the elderly group with high KPS (8.4 months in low KPS, 12.4 months in high KPS; p = 0.003). The median PFS was also significantly longer in the elderly group with high KPS (4.3 months in low KPS, 9.1 months in high KPS; p = 0.04). OS and PFS were significantly longer in the nonelderly group with resection than with biopsy (OS, p = 0.016; PFS, p = 0.039). However, neither OS nor PFS showed any difference with surgical method in the elderly group (OS, p = 0.241; PFS, p = 0.131). Conclusions: Less invasive treatment can be considered as a treatment option in addition to radical resection in glioblastoma patients aged 75 years and older with KPS on admission of less than 70, depending on the general condition.