Retr ospective study of associations of supramaximal resection with outcome in glioblastoma across age groups

The oncological role of resection in elderly patients with glioblastoma is controversial. A retrospective study by the international RANO resect group evaluated resection of IDH-wildtype glioblastoma in patients aged 65 year or older compared with patients younger than 65 years. Among 1260 patients with newly diagnosed glioblastoma (512 patients aged ≥ 65 years), lower postoperative contrast-enhancing tumor volumes were favorably associated with survival; however, the associations with outcome were more pronounced in younger patients. Only in patients < 65 years, supramaximal resection was associated with mover favorable survival (40 vs 20 months; p=0.001). Among 310 patients with first recurrence (92 aged ≥ 65 years), maximal resection of contrast-enhancing tumor was associated with favorable outcomes, particularly in younger patients. Neither younger nor older patients had favorable outcome associations of supramaximal resection in the recurrent setting. The authors conclude that while complete contrast-enhancing tumor resection is prognostic for favorable outcomes in older patients, associations of supramaximal resection with improved outcomes were only retained in younger patients with newly diagnosed disease.