1Department of Neurosurgery, USA
2Carolina Neurosurgery and Spine Associates, USA
3Levine Cancer Institute, USA
4Southeast Radiation Oncology Group, USA
*Corresponding author:David Peters, Carolinas Medical Center, USA
Submission: December 1, 2020 Published: February 10, 2021
ISSN 2637-7748Volume4 Issue1
Purpose: Management of high-grade gliomas currently relies heavily on a tissue diagnosis to guide treatment decisions, often obtained by stereotactic biopsy.Patients with unresectable high-grade gliomas have a dismal prognosis even with optimal therapy.Sparing them the cost, potential morbidity, and risk of biopsy may be in their best interest.
Method: All patients at one institution over a 9-year period (2005-2013) who had pathological confirmation of high-grade gliomas with stereotactic biopsy and did not undergo any additional surgery were included in this retrospective analysis.Data were collected on patient demographics, performance status (PS), overall survival (OS), 60-day mortality, and iatrogenic hemorrhage.
Result: 160 patients underwent analysis. Median OS was 5.1 months.46 patients died within 60 days after biopsy.8 patients suffered iatrogenic hemorrhage. Older age predicted worse OS and 60-day mortality. Combining PS and age provided superior prognostic information rather than age or PS alone.Patients with PS 0-2 and age ≤ 65 had a median OS of 10.1 months and 14% mortality within 60 days post-operatively.
Conclusion: High grade glioma patients with low performance status and/or advanced age may be better served by avoiding the cost and risk of stereotactic biopsy.Age has a strong effect on overall survival following biopsy in this cohort.In the setting of suspected unresectable high-grade glioma with poor performance status, advanced age, and low likelihood of improvement, there appears to be little gained from biopsy.Careful patient selection is necessary to avoid overtreatment in this population.
Keywords: Glioblastoma;Anaplastic astrocytoma;High-grade glioma;Stereotactic biopsy;Performance status;Inoperable brain tumor