Watch The Presentation
Presentation Description
Institution: Wellington Regional Hospital - Wellington, Aotearoa New Zealand
Purpose: Surgical resection of glioblastoma (GB) extends survival; however, at what age does surgery no longer prolong a reasonable quality of life. We examined post-operative functional independence (FI) as a proxy for quality of life in elderly patients.
Methodology: Records of patients 60 years and older who underwent surgical intervention for a GB at a single centre between August 2000 and September 2018 were retrospectively reviewed. Duration of FI post-op was determined by the first documented loss of independence with activities of daily living. Pre-op factors associated with mortality were assessed with a multivariate analysis and logistic regression model. A prognostic tool for morbidity and mortality was developed using a jackknife (hold-one-out) method for good out-of-sample performance.
Results: In total, 352 patients had a mean age of 69.1±6 years and a median survival of 7.1 months post-operation. Median months of FI was 1.3, improving to 2.7 following sub- or gross-total resections, but was 0 for those who had biopsies. In patients aged 60-64.9 years undergoing surgical resection, 74.2% (49 out of 66 patients) had FI post-op, whereas only 8.3% (1 out of 12 patients) of those 75 years and older having biopsies retained FI. Advancing age (p=0.0005), declining Karnofsky Performance Status score (p=0.007), and the presence of multifocal (p=0.002) and bilateral tumours (0.001) were significantly associated with decreased survival post-op. The prognostic models for morbidity and mortality had areas under the curve of approximately 0.72.
Conclusion: Performing biopsies in patients 75 years and older does not allow them to retain or regain FI and instead adds to their physical burden for their remaining days.
Speakers
Authors
Authors
Dr Rosanna Rahman - , Dr Robin Willink - , Dr Mira Steinmetz - , Dr Sarah Cashen - , Dr Katherine Tse - , Dr Louise Griffin -