Impact of function-guided glioma treatment on oncological outcome in the elderly
Introduction: Many patients with high-grade gliomas (HGG) are of older age. Research question: We hypothesize that pre- and intraoperative mapping and monitoring preserve functional status in elderly patients while gross total resection (GTR) is the aim, resulting in overall survival (OS) rates comp...
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Elsevier
2024-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529423010305 |
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| author | Carolin Albrecht Lea Baumgart Axel Schroeder Benedikt Wiestler Bernhard Meyer Sandro M. Krieg Sebastian Ille |
| author_facet | Carolin Albrecht Lea Baumgart Axel Schroeder Benedikt Wiestler Bernhard Meyer Sandro M. Krieg Sebastian Ille |
| author_sort | Carolin Albrecht |
| collection | DOAJ |
| description | Introduction: Many patients with high-grade gliomas (HGG) are of older age. Research question: We hypothesize that pre- and intraoperative mapping and monitoring preserve functional status in elderly patients while gross total resection (GTR) is the aim, resulting in overall survival (OS) rates comparable to the general population with HGG. Material and methods: We subdivided a prospective cohort of 168 patients above 65 years with eloquent high-grade gliomas into four groups ([years/cases] 1: 65–69/58; 2: 70–74/47; 3: 75–79/43; 4: >79/20). All patients underwent preoperative noninvasive mapping, which was also used for decision-making, intraoperative neuromonitoring in 138 cases, direct cortical and/or subcortical motor mapping in 66 and 50 cases, and awake language mapping in 11 cases. Results: GTR and subtotal resection (STR) could be achieved in 65% and 28%, respectively. Stereotactic biopsy was performed in 8% of cases. Postoperatively, we found transient and permanent functional deficits in 13% and 11% of cases. Postoperative Karnofsky Performance Scale (KPS) did not differ between subgroups. Patients with long-term follow-up (51%) had a progression-free survival of 5.5 (1–47) months and an overall survival of 10.5 (0–86) months. Discussion and conclusion: The interdisciplinary glioma treatment in the elderly is less age-dependent but must be adjusted to the functional status. Function-guided surgical resections could be performed as usual, with maximal tumor resection being the primary goal. However, less network capacity in the elderly to compensate for deficits might cause higher rates of permanent deficits in this group of patients with more fast-growing malignant gliomas. |
| format | Article |
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| institution | OA Journals |
| issn | 2772-5294 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
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| series | Brain and Spine |
| spelling | doaj-art-89bb0af79e5c4330b5ca6829b1afcb822025-08-20T02:35:47ZengElsevierBrain and Spine2772-52942024-01-01410274210.1016/j.bas.2023.102742Impact of function-guided glioma treatment on oncological outcome in the elderlyCarolin Albrecht0Lea Baumgart1Axel Schroeder2Benedikt Wiestler3Bernhard Meyer4Sandro M. Krieg5Sebastian Ille6Department of Neurosurgery, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, GermanyDepartment of Neurosurgery, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, GermanyDepartment of Neurosurgery, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, GermanySection of Diagnostic and Interventional Neuroradiology Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technische Universität München, Germany; School of Medicine, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany; Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, GermanyDepartment of Neurosurgery, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, GermanyDepartment of Neurosurgery, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, GermanyDepartment of Neurosurgery, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany; Corresponding author. Department of Neurosurgery, Technical University of Munich, Germany, School of Medicine, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany. New affiliation: Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, GermanyIntroduction: Many patients with high-grade gliomas (HGG) are of older age. Research question: We hypothesize that pre- and intraoperative mapping and monitoring preserve functional status in elderly patients while gross total resection (GTR) is the aim, resulting in overall survival (OS) rates comparable to the general population with HGG. Material and methods: We subdivided a prospective cohort of 168 patients above 65 years with eloquent high-grade gliomas into four groups ([years/cases] 1: 65–69/58; 2: 70–74/47; 3: 75–79/43; 4: >79/20). All patients underwent preoperative noninvasive mapping, which was also used for decision-making, intraoperative neuromonitoring in 138 cases, direct cortical and/or subcortical motor mapping in 66 and 50 cases, and awake language mapping in 11 cases. Results: GTR and subtotal resection (STR) could be achieved in 65% and 28%, respectively. Stereotactic biopsy was performed in 8% of cases. Postoperatively, we found transient and permanent functional deficits in 13% and 11% of cases. Postoperative Karnofsky Performance Scale (KPS) did not differ between subgroups. Patients with long-term follow-up (51%) had a progression-free survival of 5.5 (1–47) months and an overall survival of 10.5 (0–86) months. Discussion and conclusion: The interdisciplinary glioma treatment in the elderly is less age-dependent but must be adjusted to the functional status. Function-guided surgical resections could be performed as usual, with maximal tumor resection being the primary goal. However, less network capacity in the elderly to compensate for deficits might cause higher rates of permanent deficits in this group of patients with more fast-growing malignant gliomas.http://www.sciencedirect.com/science/article/pii/S2772529423010305ElderlyGlioblastomaMappingNeuromonitoringTms |
| spellingShingle | Carolin Albrecht Lea Baumgart Axel Schroeder Benedikt Wiestler Bernhard Meyer Sandro M. Krieg Sebastian Ille Impact of function-guided glioma treatment on oncological outcome in the elderly Brain and Spine Elderly Glioblastoma Mapping Neuromonitoring Tms |
| title | Impact of function-guided glioma treatment on oncological outcome in the elderly |
| title_full | Impact of function-guided glioma treatment on oncological outcome in the elderly |
| title_fullStr | Impact of function-guided glioma treatment on oncological outcome in the elderly |
| title_full_unstemmed | Impact of function-guided glioma treatment on oncological outcome in the elderly |
| title_short | Impact of function-guided glioma treatment on oncological outcome in the elderly |
| title_sort | impact of function guided glioma treatment on oncological outcome in the elderly |
| topic | Elderly Glioblastoma Mapping Neuromonitoring Tms |
| url | http://www.sciencedirect.com/science/article/pii/S2772529423010305 |
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