Surg-39. surgical resection of glioblastoma in elderly patients: the potential role of 5-ala fluorescence guidance

Glioblastoma (GBM) is the most common primary brain tumor in adults and commonly occurs in individuals aged 65 years or older. The prognosis of elderly patients with GBM is universally poor: their median survival ranges from 4 to 9 months. The main reason is that older patients are often treated more conservatively than younger; this is a result of reluctance to offer aggressive treatment for fear of postoperative complications. Several series report that the 5-ALA fluorescence-guided resection increases the extension of tumor removal, improving survival. The aim of this study is to evaluate the impact of 5-ALA on outcomes in elderly GBM. The present experience is related to 36 patients (32 newly diagnosed and 4 recurrent GBM). At diagnosis the age ranged from 65 to 79 years. Co-morbidities (CM) were identified with CIRS scale. All the patients have been submitted to radiotherapy and/or chemotherapy; second and in some cases third line treatments were utilized in recurrent cases. Follow-up ranged from 1 year to 2 years. In more than 90 % of patients tumour tissue showed intraoperative red fluorescence; mainly in recurrent GBM, when MRI documented heterogeneous lesions with enhancing areas mixed with gliotic scars, fluorescence-guided surgery allowed a better definition of active tumor, with net margins from perilesional "healthy" brain. Early postoperative MRI confirmed gross total resection without contrast enhancement in 80 % of patients. In the pre...
Source: Neuro-Oncology - Category: Cancer & Oncology Authors: Tags: SURGICAL THERAPY Source Type: research