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How Old is Too Old for Glioblastoma Surgery?

2 hands resting together, old and youngOne of the most dangerous kinds of brain tumors is called a glioblastoma. It’s known for the aggressive way it spreads, infiltrating healthy brain tissue around it.

Surgery is the main treatment for glioblastoma. It doesn’t always cure the disease, but it can extend the lives of patients who undergo the procedure.

Not much is known about the safety and effectiveness of glioblastoma surgery in elderly patients. And glioblastoma is actually more common in older adults.

A team that includes three of our most senior researchers aims to fill this knowledge gap. Dr. Michael Sisti, Dr. Jeffrey BruceDr. Guy McKhann, and others (full list below) have published a paper that evaluates surgery as an option for older glioblastoma patients. The lead author of the paper is fourth-year resident Dr. Randy D’Amico.

As the researchers explain, this knowledge gap exists because elderly patients with glioblastoma usually aren’t part of treatment studies. Sometimes that’s because these patients have other medical problems that keep them out of the studies.

But other times, there is just an assumption that elderly patients will not do well with an aggressive brain tumor surgery. Doctors end up giving elderly patients more conservative care instead of surgery.

But doctors here at Columbia’s Department of Neurosurgery aren’t satisfied with that blanket assumption. For this study, the researchers looked at data from hundreds of glioblastoma patients treated at Columbia University Medical Center/NewYork-Presbyterian Hospital over the course of twelve years. The patients in the study were older adults–between 65 and 92 years old. Just over three-quarters of them had glioblastoma surgery.

authors of new paper on age and glioblastoma surgery
Dr. Michael Sisti, Dr. Jeffrey Bruce, and Dr. Guy McKhann

The researchers found that age alone can’t predict surgical outcomes. In this study, the elderly patients who had surgery did about as well as non-elderly patients who had surgery in other studies.

This finding doesn’t mean that surgery is a great option for all elderly patients, across the board. For one thing, comparing results between one center and another is not straightforward. CUMC/NYPH  has experienced surgeons and an excellent track record. The elderly patients in this study might have done especially well for that reason.

For another thing, many of the elderly patients in this study–almost a quarter of them–did not have surgery. Some of these patients were in poor cardiovascular or general health, making surgery riskier. In other cases, the tumor location made surgery a less appealing option. Thus the group of patients who were found to do well with surgery had been selected as more likely to do well.

But these other factors were part of the treatment decision. The patients’ age alone did not automatically put them in the “no surgery” camp. As the paper puts it:

“In carefully selected elderly patients, surgical resection is likely a safe therapeutic option for both primary and recurrent disease … [It] should be considered as part of an aggressive treatment approach.”

Doctors and patients still need to work together to form individual treatment plans. Surgery isn’t the best option for every patient, regardless of age. But this research suggests that advanced age is no reason to dismiss the option out of hand.

Learn more about Dr. Sisti on his bio page here.

Learn more about Dr. Bruce on his bio page here.

Learn more about Dr. McKahnn on his bio page here.

FULL LIST OF AUTHORS: Randy S. D’Amico, MD; Michael B. Cloney; Adam M. Sonabend, MD; Brad Zacharia, MD, MS; Matthew N. Nazarian; Fabio M. Iwamoto; Michael B. Sisti, MD; Jeffrey N. Bruce, MD; Guy M. McKhann II, MD

Image credit: [PublicDomainPictures] / Pixabay

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