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.