Surgery for high‐grade gliomas in the aging

Objective High‐grade glioma ( HGG ) is the commonest primary brain tumor in adults. We prospectively assessed outcome following surgery and adjuvant treatment for HGG in older patients. Materials and methods Patients ≥ 60 years undergoing craniotomies for gliomas WHO grade 3 and 4 at O slo and H aukeland U niversity H ospitals 2008–2009 were included ( n  = 80). Outcome was assessed at six months, and overall mortality evaluated at two years. Results Forty‐two males and 38 females of median age 68.5 (60–83) years were included, 35% attended a follow‐up appointment at six months. Surgical mortality was 1.3%. Surgical morbidity included neurological sequela (10%), post‐operative hematomas (3.8%) and hydrocephalus (1.3%). Median overall survival was 8.4 months and significantly increased by adjuvant radiochemotherapy. In univariate survival analyses, age ≥ 80 years, subtotal resection, American Society of Anesthesiology ( ASA ) scores 3–4, Karnofsky performance scale ( KPS ) < 70, and mini–mental state examination ( MMSE ) score < 25 significantly reduced survival. Conclusions Surgical treatment of HGG carries low mortality and acceptable morbidity in patients aged ≥ 60 years. There is improved survival following bimodal adjuvant treatment. Maximum tumor resection should be attempted. Treatment might be less beneficial in patients aged ≥ 80 years and in those with poor pre‐operative function.