Debulking or biopsy of malignant glioma in elderly people - A randomised study

  • Vuorinen V
  • Hinkka S
  • Färkkilä M
 et al. 
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Abstract

Background. Patients with radiologically (MRI and/or CT im- ages) suspected malignant glioma is referred to radiotherapy after craniotomy and resection of the tumour or after diagnostic biopsy. Patients with poor preoperative status and elderly patients are diag- nosed more often by biopsy and treated by radiotherapy rather than by craniotomy and tumour resection. However, based on previous retrospective studies it is not possible to conclude which procedure is better for elderly patients. Thus a prospective study comparing these two procedures with elderly patients was planned. Methods. 30 patients older than 65 years with radiologically (CT and/or MRI) obvious malignant glioma were randomised into two groups: I) stereotactic biopsy and II) open craniotomy and resection of the tumour. Nineteen patients were diagnosed to have grade IV glioma and four patients grade III glioma. Seven out of 30 (23%) were followed in the ‘‘intention-to-treat’’ group with diagnosis of stroke (n ¼ 3), metastasis (n ¼ 2), malignant lymphoma (n ¼ 1) and one with out histological diagnosis. Patients with histologically veri- fied malignant glioma (grade III–IV) were diagnosed by stereotactic biopsy (n ¼ 13) or by open craniotomy and resection (n ¼ 10) and all the patients were referred to radiotherapy. Survival and time of deteriorationwere followed. Findings. The overall mediansurvival time was 146 (95% CI 89–175) days after the procedure. The estimated mediansurvival time was 171 (95% CI 146–278) days after the craniotomy versus 85 (95% CI 55–157) days after the biopsy (p ¼ 0.035). The estimated survival time was 2.757 times longer (95% CI 1.004–7.568, p ¼ 0.049) after craniotomy. However, there was no significant dif- ference in the time of deteriorationbetweenthese two treatments (p ¼ 0.057). Amount of radiotherapy given had a significant e¤ect onsurvival (p ¼ 0.001). Interpretation. Longer survival time is achieved after open cra- niotomy and resection of tumour. However, overall benefit of open surgery to patient seems to be modest, while time of deterioration did not di¤er between two treatment groups. Our results support previous studies on the benefit of radiotherapy in the treatment of ma- lignant glioma.

Author-supplied keywords

  • Biopsy
  • Malignant glioma
  • Radiotherapy
  • Resection

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