• David Fogg, Zachary C Gersey, Matthew Pease, Arka N Mallela, Edward Andrews, Tritan Plute, Thomas M Pearce, Confidence Njoku-Austin, Austin Anthony, Nduka M Amankulor, and Pascal Zinn.
• University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
• World Neurosurg. 2023 Oct 1; 178: e540e548e540-e548.

ObjectiveThe current standard of care for patients with glioblastoma (GBM) is maximal safe resection followed by adjuvant radiation therapy with concurrent temozolomide chemotherapy. Previous studies that identified this treatment regimen focused on younger patients with GBM. The proportion of patients with GBM over the age of 80 years is increasing. We investigate whether elderly patients benefit from the current standard of care with additional maximal safe resection.MethodsClinical, operative, radiographic, demographic, genetic, and outcomes data were retrospectively collected for patients treated for histologically confirmed World Health Organization grade 4 GBM at University of Pittsburgh Medical Center from 2009 to 2020. Only patients 80 years and older were included (n = 123). Statistically significant values were set at P < 0.05.ResultsA univariate Cox proportional hazards analysis of GBM patients aged >80 years identified the use of temozolomide, radiation, Karnofsky Performance Status (KPS) > 70, and methylguanine DNA methyltransferase methylation with increased overall survival (OS). Further multivariate Cox proportional hazards model analysis showed that the variables identified in the univariate analysis passed multicollinearity testing, and that use of temozolomide, KPS >70, and gross total resection were shown to significantly impact survival. Survival analysis showed that patients with biopsy alone had a shorter median OS compared with patients who received resection, temozolomide, and radiation (P < 0.0001, median OS 1.6 vs. 7.5 months). Additionally, patients who underwent biopsy and then received temozolomide and radiation had a shorter median OS when compared with patients who received resection, temozolomide, and radiation (P = 0.0047, median OS 3.6 vs. 7.5 months).ConclusionsFor elderly patients with KPS >70, GTR followed by radiation and temozolomide is associated with maximum OS.Copyright © 2023 Elsevier Inc. All rights reserved.

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