PDF(Pubmed)
Abstract：
UNASSIGNED: Many patients with high-grade gliomas (HGG) are of older age.
UNASSIGNED: We hypothesize that pre- and intraoperative mapping and monitoring preserve functional status in elderly patients while gross total resection (GTR) is the aim, resulting in overall survival (OS) rates comparable to the general population with HGG.
UNASSIGNED: We subdivided a prospective cohort of 168 patients above 65 years with eloquent high-grade gliomas into four groups ([years/cases] 1: 65-69/58; 2: 70-74/47; 3: 75-79/43; 4: >79/20). All patients underwent preoperative noninvasive mapping, which was also used for decision-making, intraoperative neuromonitoring in 138 cases, direct cortical and/or subcortical motor mapping in 66 and 50 cases, and awake language mapping in 11 cases.
UNASSIGNED: GTR and subtotal resection (STR) could be achieved in 65% and 28%, respectively. Stereotactic biopsy was performed in 8% of cases. Postoperatively, we found transient and permanent functional deficits in 13% and 11% of cases. Postoperative Karnofsky Performance Scale (KPS) did not differ between subgroups. Patients with long-term follow-up (51%) had a progression-free survival of 5.5 (1-47) months and an overall survival of 10.5 (0-86) months.
UNASSIGNED: The interdisciplinary glioma treatment in the elderly is less age-dependent but must be adjusted to the functional status. Function-guided surgical resections could be performed as usual, with maximal tumor resection being the primary goal. However, less network capacity in the elderly to compensate for deficits might cause higher rates of permanent deficits in this group of patients with more fast-growing malignant gliomas.
UNASSIGNED: We hypothesize that pre- and intraoperative mapping and monitoring preserve functional status in elderly patients while gross total resection (GTR) is the aim, resulting in overall survival (OS) rates comparable to the general population with HGG.
UNASSIGNED: We subdivided a prospective cohort of 168 patients above 65 years with eloquent high-grade gliomas into four groups ([years/cases] 1: 65-69/58; 2: 70-74/47; 3: 75-79/43; 4: >79/20). All patients underwent preoperative noninvasive mapping, which was also used for decision-making, intraoperative neuromonitoring in 138 cases, direct cortical and/or subcortical motor mapping in 66 and 50 cases, and awake language mapping in 11 cases.
UNASSIGNED: GTR and subtotal resection (STR) could be achieved in 65% and 28%, respectively. Stereotactic biopsy was performed in 8% of cases. Postoperatively, we found transient and permanent functional deficits in 13% and 11% of cases. Postoperative Karnofsky Performance Scale (KPS) did not differ between subgroups. Patients with long-term follow-up (51%) had a progression-free survival of 5.5 (1-47) months and an overall survival of 10.5 (0-86) months.
UNASSIGNED: The interdisciplinary glioma treatment in the elderly is less age-dependent but must be adjusted to the functional status. Function-guided surgical resections could be performed as usual, with maximal tumor resection being the primary goal. However, less network capacity in the elderly to compensate for deficits might cause higher rates of permanent deficits in this group of patients with more fast-growing malignant gliomas.
摘要：
■许多高级别神经胶质瘤（HGG）患者年龄较大。
■我们假设术前和术中定位和监测保持老年患者的功能状态，而总切除（GTR）是目标，导致总生存率（OS）与HGG的普通人群相当。
■我们将168例65岁以上的高级别胶质瘤患者的前瞻性队列细分为四组（[年数]1：65-69/58；2：70-74/47；3：75-79/43；4：>79/20）。所有患者均接受术前无创标测,也用于决策，138例术中神经监护,直接皮质和/或皮质下运动标测66例和50例，和清醒语言映射11例。
■GTR和次全切除（STR）可以实现65％和28％，分别。8％的病例进行了立体定向活检。术后,我们发现13%和11%的病例存在暂时性和永久性功能缺陷.术后Karnofsky性能量表（KPS）在亚组之间没有差异。长期随访的患者（51％）的无进展生存期为5.5（1-47）个月，总生存期为10.5（0-86）个月。
■老年人的跨学科神经胶质瘤治疗对年龄的依赖性较小，但必须根据功能状态进行调整。功能引导的手术切除可以照常进行，最大限度的肿瘤切除是首要目标。然而,老年人弥补缺陷的网络容量较少,可能会导致该组恶性神经胶质瘤生长较快的患者出现永久性缺陷的比率较高.
■我们假设术前和术中定位和监测保持老年患者的功能状态，而总切除（GTR）是目标，导致总生存率（OS）与HGG的普通人群相当。
■我们将168例65岁以上的高级别胶质瘤患者的前瞻性队列细分为四组（[年数]1：65-69/58；2：70-74/47；3：75-79/43；4：>79/20）。所有患者均接受术前无创标测,也用于决策，138例术中神经监护,直接皮质和/或皮质下运动标测66例和50例，和清醒语言映射11例。
■GTR和次全切除（STR）可以实现65％和28％，分别。8％的病例进行了立体定向活检。术后,我们发现13%和11%的病例存在暂时性和永久性功能缺陷.术后Karnofsky性能量表（KPS）在亚组之间没有差异。长期随访的患者（51％）的无进展生存期为5.5（1-47）个月，总生存期为10.5（0-86）个月。
■老年人的跨学科神经胶质瘤治疗对年龄的依赖性较小，但必须根据功能状态进行调整。功能引导的手术切除可以照常进行，最大限度的肿瘤切除是首要目标。然而,老年人弥补缺陷的网络容量较少,可能会导致该组恶性神经胶质瘤生长较快的患者出现永久性缺陷的比率较高.
