122 Surgical Outcomes for High Grade Glioma in Patients Aged 70 Years and Older: A 10 Year Single Centre Cohort Study

Abstract

High‑grade gliomas are increasingly diagnosed in older adults, but surgical risks and benefits beyond age 70 remain uncertain. This study reports a 10‑year single‑centre experience of surgical management and outcomes in patients aged ≥70 years with high‑grade glioma. A retrospective cohort analysis was conducted for patients aged ≥70 years who underwent surgery for WHO grade 3–4 glioma between 2015–2025. Data included demographics, performance status, tumour features, surgical strategy (biopsy, subtotal or gross total resection), adjunctive techniques, complications, adjuvant therapy, and survival. Primary outcome was overall survival; secondary outcomes were 30‑day mortality, complication rates, and postoperative functional change. Among 197 patients (mean age 74; 124 males), most tumours were temporal (31%), frontal (28%), or parietal (21%). Pre‑operative performance status was good (PS 0–1) in 56%, moderate (PS 2) in 32%, and poor (PS 3–4) in 12%. Surgery comprised biopsy in 54, subtotal resection in 95, and gross total resection in 48 patients. MGMT promoter methylation was detected in 80 cases. Common symptoms included motor deficit (46%) and speech disturbance (35%). Postoperative radiotherapy was given to 100 patients, chemotherapy to 81, and combined chemoradiotherapy to 59. Mean overall survival was 9.3 months; 192 patients had died at last follow‑up, with only 5 alive. Tumour progression occurred in 89 patients, with limited repeat surgery (n = 2). Elderly patients (≥70 years) undergoing surgery for high‑grade glioma achieved survival outcomes comparable to contemporary series (≈9 months). Most were able to receive adjuvant therapy, supporting a proactive, performance‑status–guided surgical and oncological approach rather than restriction based on age alone.