Survival and Function in Elderly Patients with GBM: the Role of Surgical Resection with Contemporary Multi-Modal Therapy

Purpose: Is maximal safe resection performed by a single surgeon associated with better overall survival and preserved functional outcomes in elderly patients with GBM compared to biopsy alone in a single-institution with homogenous clinical protocols? Methods: We conducted a single-surgeon, single-center retrospective cohort study of patients aged ≥ 70 years treated between 2016 and 2024, including a subgroup of octogenarians, to compare survival following resection versus biopsy for lobar GBM. Results: Among 82 patients, 65 (79.3%) underwent resection and 17 (20.7%) biopsy. Median survival was significantly longer after resection than biopsy (8.8 vs 2.7 months). On multivariate Cox analysis adjusting for radiation, temozolomide, MGMT status, and ASA score, resection remained associated with improved survival (HR = 0.34, 95% CI = 0.19–0.63, p < 0.001). The survival benefit persisted in both MGMT-methylated and unmethylated tumors but was observed only among patients receiving adjuvant therapy. In octogenarians, resection was independently associated with improved survival (HR = 0.28, 95% CI = 0.10–0.81, p = 0.018), with greatest benefit in MGMT-methylated tumors and those treated with temozolomide. Functional outcomes were preserved following resection, with 63.6%, 69.2%, and 70.8% maintaining ECOG < 2 at 3, 6, and 12 months, respectively, including octogenarians. Nine patients (11%) survived beyond two years; all achieved gross total resection, had MGMT-methylated tumors, and completed full adjuvant therapy. Conclusions: By minimizing inter-surgeon variability and applying uniform adjuvant protocols, these findings support consideration of maximal safe resection in carefully selected elderly GBM patients when combined with multimodal treatment.