UCSF

Abstract Introduction: Low-grade gliomas are mostly commonly diagnosed in patients in the third and fourth decade of life, and are not commonly seen in patients older patients. Thus there is a lack of consensus in disease management within this age group. While maximizing the extent of resection has been reported to improve outcomes in patients with low-grade gliomas, data in the subgroup of individuals over the age of 60 is limited, and there are some reports that outcomes are worse compared to younger counterparts. While in younger patients, an aggressive resection may obviate the need for adjuvant therapy, in older patients, upfront adjuvant therapy has been advocated regardless of the extent of resection achieved. Thus, some practitioners may feel an aggressive resection is worth pursuing in older patients given the increased perioperative morbidity profile. Materials and Methods: In order to assess whether these patients may be safely treated with and benefit from aggressive surgical resection, we identified 22 patients at least 60 years of age who had undergone resection of a ­low-grade glioma between January 1997 and September 2015. Pre-operative and post-operative tumor volumes were quantified using BrainLab Smartbrush software. To quantify tumor volume, manual segmentation was performed with region-of-interest analysis based on T2 or fluid-attenuated inversion-recovery (FLAIR) sequences from pre- and post-operative MRI scans. Results: Mean age at the time of surgery was 65.55 years (range 61.16 - 71.8) with a median follow-up period of 3.4 years. Pathologic diagnoses included oligodendrogliomas (65%), diffuse astrocytomas (18.18%), and mixed oligoastrocytomas (22.72%). Surgical resection was performed with either language and/or motor mapping in 82% of patients. Mean volumetric extent of resection was 75.05%. No worsened or new neurological deficits were seen in 73% of patients post-operatively. One- and 2-year progression free survival (PFS) rates were found to be 81.25% and 57.14%, respectively, for patients with adequate follow-up. CONCLUSION: This evidence suggests that an aggressive resection strategy can be applied safely to older patients with low-grade gliomas.