High Grade Glioma Treatment in Elderly People: Is It Different Than in Younger Patients? Analysis of Surgical Management Guided by an Intraoperative Multimodal Approach and Its Impact on Clinical Outcome
ObjectiveAge is considered a negative prognostic factor for High Grade Gliomas (HGGs) and many neurosurgeons remain skeptical about the benefits of aggressive treatment. New surgical and technological improvements may allow extended safe resection, with lower level of post-operative complications. T...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-02-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2020.631255/full |
| _version_ | 1828963507703382016 |
|---|---|
| author | Giuseppe Maria Vincenzo Barbagallo Giuseppe Maria Vincenzo Barbagallo Roberto Altieri Roberto Altieri Roberto Altieri Marco Garozzo Massimiliano Maione Stefania Di Gregorio Massimiliano Visocchi Simone Peschillo Pasquale Dolce Francesco Certo Francesco Certo |
| author_facet | Giuseppe Maria Vincenzo Barbagallo Giuseppe Maria Vincenzo Barbagallo Roberto Altieri Roberto Altieri Roberto Altieri Marco Garozzo Massimiliano Maione Stefania Di Gregorio Massimiliano Visocchi Simone Peschillo Pasquale Dolce Francesco Certo Francesco Certo |
| author_sort | Giuseppe Maria Vincenzo Barbagallo |
| collection | DOAJ |
| description | ObjectiveAge is considered a negative prognostic factor for High Grade Gliomas (HGGs) and many neurosurgeons remain skeptical about the benefits of aggressive treatment. New surgical and technological improvements may allow extended safe resection, with lower level of post-operative complications. This opportunity opens the unsolved question about the most appropriate HGG treatment in elderly patients. The aim of this study is to analyze if HGG maximal safe resection guided by an intraoperative multimodal imaging protocol coupled with neuromonitoring is associated with differences in outcome in elderly patients versus younger ones.MethodsWe reviewed 100 patients, 53 (53%) males and 47 (47%) females, with median (IQR) age of 64 (57; 72) years. Eight patients were diagnosed with Anaplastic Astrocytoma (AA), 92 with Glioblastoma (GBM). Surgery was aimed to achieve safe maximal resection. An intraoperative multimodal imaging protocol, including neuronavigation, neurophysiological monitoring, 5-ALA fluorescence, 11C MET-PET, navigated i-US system and i-CT, was used, and its impact on EOTR and clinical outcome in elderly patients was analyzed. We divided patients in two groups according to their age: <65 and >65 years, and surgical and clinical results (EOTR, post-operative KPS, OS and PFS) were compared. Yet, to better understand age-related differences, the same patient cohort was also divided into <70 and >70 years and all the above data reanalyzed.ResultsIn the first cohort division, we did not found KPS difference over time and survival analysis did not show significant difference between the two groups (p = 0.36 for OS and p = 0.49 for PFS). Same results were obtained increasing the age cut-off for age up to 70 years (p = 0.52 for OS and p = 0.92 for PFS).ConclusionsOur data demonstrate that there is not statistically significant difference in post-operative EOTR, KPS, OS, and PFS between younger and elderly patients treated with extensive tumor resection aided by a intraoperative multimodal protocol. |
| first_indexed | 2024-12-14T10:29:27Z |
| format | Article |
| id | doaj.art-041ea4358e4d42efaa38fe0f4d737f76 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-14T10:29:27Z |
| publishDate | 2021-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-041ea4358e4d42efaa38fe0f4d737f762022-12-21T23:06:11ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-02-011010.3389/fonc.2020.631255631255High Grade Glioma Treatment in Elderly People: Is It Different Than in Younger Patients? Analysis of Surgical Management Guided by an Intraoperative Multimodal Approach and Its Impact on Clinical OutcomeGiuseppe Maria Vincenzo Barbagallo0Giuseppe Maria Vincenzo Barbagallo1Roberto Altieri2Roberto Altieri3Roberto Altieri4Marco Garozzo5Massimiliano Maione6Stefania Di Gregorio7Massimiliano Visocchi8Simone Peschillo9Pasquale Dolce10Francesco Certo11Francesco Certo12Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, ItalyInterdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, ItalyDepartment of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, ItalyInterdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, ItalyDepartment of Neuroscience, University of Turin, Turin, ItalyDepartment of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, ItalyDepartment of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, ItalyDepartment of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, ItalyNeurosurgical Unit, Catholic University, Rome, ItalyDepartment of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, ItalyDepartment of Public Health, University of Naples Federico II, Naples, ItalyDepartment of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, ItalyInterdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, ItalyObjectiveAge is considered a negative prognostic factor for High Grade Gliomas (HGGs) and many neurosurgeons remain skeptical about the benefits of aggressive treatment. New surgical and technological improvements may allow extended safe resection, with lower level of post-operative complications. This opportunity opens the unsolved question about the most appropriate HGG treatment in elderly patients. The aim of this study is to analyze if HGG maximal safe resection guided by an intraoperative multimodal imaging protocol coupled with neuromonitoring is associated with differences in outcome in elderly patients versus younger ones.MethodsWe reviewed 100 patients, 53 (53%) males and 47 (47%) females, with median (IQR) age of 64 (57; 72) years. Eight patients were diagnosed with Anaplastic Astrocytoma (AA), 92 with Glioblastoma (GBM). Surgery was aimed to achieve safe maximal resection. An intraoperative multimodal imaging protocol, including neuronavigation, neurophysiological monitoring, 5-ALA fluorescence, 11C MET-PET, navigated i-US system and i-CT, was used, and its impact on EOTR and clinical outcome in elderly patients was analyzed. We divided patients in two groups according to their age: <65 and >65 years, and surgical and clinical results (EOTR, post-operative KPS, OS and PFS) were compared. Yet, to better understand age-related differences, the same patient cohort was also divided into <70 and >70 years and all the above data reanalyzed.ResultsIn the first cohort division, we did not found KPS difference over time and survival analysis did not show significant difference between the two groups (p = 0.36 for OS and p = 0.49 for PFS). Same results were obtained increasing the age cut-off for age up to 70 years (p = 0.52 for OS and p = 0.92 for PFS).ConclusionsOur data demonstrate that there is not statistically significant difference in post-operative EOTR, KPS, OS, and PFS between younger and elderly patients treated with extensive tumor resection aided by a intraoperative multimodal protocol.https://www.frontiersin.org/articles/10.3389/fonc.2020.631255/fullelderlyglioblastomaglioma5ALAgeriatric populationbrain tumor |
| spellingShingle | Giuseppe Maria Vincenzo Barbagallo Giuseppe Maria Vincenzo Barbagallo Roberto Altieri Roberto Altieri Roberto Altieri Marco Garozzo Massimiliano Maione Stefania Di Gregorio Massimiliano Visocchi Simone Peschillo Pasquale Dolce Francesco Certo Francesco Certo High Grade Glioma Treatment in Elderly People: Is It Different Than in Younger Patients? Analysis of Surgical Management Guided by an Intraoperative Multimodal Approach and Its Impact on Clinical Outcome Frontiers in Oncology elderly glioblastoma glioma 5ALA geriatric population brain tumor |
| title | High Grade Glioma Treatment in Elderly People: Is It Different Than in Younger Patients? Analysis of Surgical Management Guided by an Intraoperative Multimodal Approach and Its Impact on Clinical Outcome |
| title_full | High Grade Glioma Treatment in Elderly People: Is It Different Than in Younger Patients? Analysis of Surgical Management Guided by an Intraoperative Multimodal Approach and Its Impact on Clinical Outcome |
| title_fullStr | High Grade Glioma Treatment in Elderly People: Is It Different Than in Younger Patients? Analysis of Surgical Management Guided by an Intraoperative Multimodal Approach and Its Impact on Clinical Outcome |
| title_full_unstemmed | High Grade Glioma Treatment in Elderly People: Is It Different Than in Younger Patients? Analysis of Surgical Management Guided by an Intraoperative Multimodal Approach and Its Impact on Clinical Outcome |
| title_short | High Grade Glioma Treatment in Elderly People: Is It Different Than in Younger Patients? Analysis of Surgical Management Guided by an Intraoperative Multimodal Approach and Its Impact on Clinical Outcome |
| title_sort | high grade glioma treatment in elderly people is it different than in younger patients analysis of surgical management guided by an intraoperative multimodal approach and its impact on clinical outcome |
| topic | elderly glioblastoma glioma 5ALA geriatric population brain tumor |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2020.631255/full |
| work_keys_str_mv | AT giuseppemariavincenzobarbagallo highgradegliomatreatmentinelderlypeopleisitdifferentthaninyoungerpatientsanalysisofsurgicalmanagementguidedbyanintraoperativemultimodalapproachanditsimpactonclinicaloutcome AT giuseppemariavincenzobarbagallo highgradegliomatreatmentinelderlypeopleisitdifferentthaninyoungerpatientsanalysisofsurgicalmanagementguidedbyanintraoperativemultimodalapproachanditsimpactonclinicaloutcome AT robertoaltieri highgradegliomatreatmentinelderlypeopleisitdifferentthaninyoungerpatientsanalysisofsurgicalmanagementguidedbyanintraoperativemultimodalapproachanditsimpactonclinicaloutcome AT robertoaltieri highgradegliomatreatmentinelderlypeopleisitdifferentthaninyoungerpatientsanalysisofsurgicalmanagementguidedbyanintraoperativemultimodalapproachanditsimpactonclinicaloutcome AT robertoaltieri highgradegliomatreatmentinelderlypeopleisitdifferentthaninyoungerpatientsanalysisofsurgicalmanagementguidedbyanintraoperativemultimodalapproachanditsimpactonclinicaloutcome AT marcogarozzo highgradegliomatreatmentinelderlypeopleisitdifferentthaninyoungerpatientsanalysisofsurgicalmanagementguidedbyanintraoperativemultimodalapproachanditsimpactonclinicaloutcome AT massimilianomaione highgradegliomatreatmentinelderlypeopleisitdifferentthaninyoungerpatientsanalysisofsurgicalmanagementguidedbyanintraoperativemultimodalapproachanditsimpactonclinicaloutcome AT stefaniadigregorio highgradegliomatreatmentinelderlypeopleisitdifferentthaninyoungerpatientsanalysisofsurgicalmanagementguidedbyanintraoperativemultimodalapproachanditsimpactonclinicaloutcome AT massimilianovisocchi highgradegliomatreatmentinelderlypeopleisitdifferentthaninyoungerpatientsanalysisofsurgicalmanagementguidedbyanintraoperativemultimodalapproachanditsimpactonclinicaloutcome AT simonepeschillo highgradegliomatreatmentinelderlypeopleisitdifferentthaninyoungerpatientsanalysisofsurgicalmanagementguidedbyanintraoperativemultimodalapproachanditsimpactonclinicaloutcome AT pasqualedolce highgradegliomatreatmentinelderlypeopleisitdifferentthaninyoungerpatientsanalysisofsurgicalmanagementguidedbyanintraoperativemultimodalapproachanditsimpactonclinicaloutcome AT francescocerto highgradegliomatreatmentinelderlypeopleisitdifferentthaninyoungerpatientsanalysisofsurgicalmanagementguidedbyanintraoperativemultimodalapproachanditsimpactonclinicaloutcome AT francescocerto highgradegliomatreatmentinelderlypeopleisitdifferentthaninyoungerpatientsanalysisofsurgicalmanagementguidedbyanintraoperativemultimodalapproachanditsimpactonclinicaloutcome |