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Debulking or biopsy of malignant glioma in
elderly people - a randomised study
Vuorinen V, Hinkka S, Farkkila M, Jaaskelainen J
Department of Neurosurgery, Turku University Hospital, Finland.
Background. Patients
with radiologically (MRI and/or CT images) suspected malignant glioma is
referred to radiotherapy after craniotomy and resection of the tumour or after
diagnostic biopsy.
Patients with poor preoperative status and elderly patients are diagnosed more
often by biopsy and treated by radiotherapy rather than by craniotomy and tumour
resection.
However, based on previous retrospective studies it is not possible to conclude
which procedure is better for elderly patients.
Thus a prospective study comparing these two procedures with elderly patients
was planned.
Methods. 30 patients
older than 65 years with radiologically (CT and/or MRI) obvious malignant glioma
were randomised into two groups: I) stereotactic biopsy and II) open craniotomy
and resection of the tumour.
Nineteen patients were diagnosed to have grade IV glioma and four patients grade
III glioma.
Seven out of 30 (23%) were followed in the "intention-to-treat" group
with diagnosis of stroke (n=3), metastasis (n=2), malignant lymphoma (n=1) and
one with out histological diagnosis.
Patients with histologically verified malignant glioma (grade III-IV) were
diagnosed by stereotactic biopsy (n=13) or by open craniotomy and resection
(n=10) and all the patients were referred to radiotherapy.
Survival and time of deterioration were followed.
Findings. The overall
median survival time was 146 (95% CI 89-175) days after the procedure.
The estimated median survival time was 171 (95% CI 146-278) days after the
craniotomy versus 85 (95% CI 55-157) days after the biopsy (p=0.035).
The estimated survival time was 2.757 times longer (95% CI 1.004-7.568, p=0.049)
after craniotomy.
However, there was no significant difference in the time of deterioration
between these two treatments (p=0.057).
Amount of radiotherapy given had a significant effect on survival
(p=0.001).
Interpretation.Longer
survival time is achieved after open craniotomy and resection of tumour.
However, overall benefit of open surgery to patient seems to be modest, while
time of deterioration did not differ between two treatment groups.
Our results support previous studies on the benefit of radiotherapy in the
treatment of malignant glioma.
PMID: 12545256 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=12545256&dopt=Abstract
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