THE LIMITED VALUE OF CYTOREDUCTIVE SURGERY IN ELDERLY PATIENTS WITH MALIGNANT GLIOMAS

IN THIS RETROSPECTIVE, consecutive series of 128 elderly patients (ove r 65 years of age) with histologically proven Grade 4 astrocytomas, 88 patients underwent stereotactic biopsy and 40 patients underwent ster eotactic volumetric resection of the mass lesion defined by contrast e nhancement on computed tomography. There were no significant differenc es in age (average age in the biopsy group, 71.6 yr; resection group, 70.15 yr) or Karnofsky Performance Scores (biopsy group, 84.33; resect ion group, 83.88) between the two groups. Four of the biopsy patients and one of the resection patients died within 30 days of surgery. The overall mean survival was 126 days; 108 days (15.4 wk) in the patients who had biopsies and 189 days (27 wk) in the patients who had resecti ons. Radiation therapy was completed in 62 of the patients who had bio psies (mean survival, 118 d or 16.9 wk) and 34 of the patients undergo ing resection (mean survival, 210 d or 30 wk) (log rank P = 0.0215; Sm irnov P = 0.006). Although some prolongation of survival is noted afte r resection (more than after a biopsy) in selected patients over 65 ye ars of age, that benefit is modest.