Background: Glioblastoma (GB) is well known for being the most aggressive primary cerebral malignancy. The peak incidence is at 60-70 years of age, with over half of patients aged over 65 years at diagnosis. Methods: Patients with a confirmed histological diagnosis of GB between January 2009 and June 2016 at a single center were retrospectively identified. The inclusion criteria for the study were age over 65 years at diagnosis, and surgical management with either a burr hole biopsy or craniotomy. Results: A total of n = 289 patients underwent surgery for GB, with a median age at diagnosis of 71 years, and of whom 64% were male. Craniotomies were performed in 71%, with burr hole biopsies performed in the remainder (29%). Patient survival differed significantly with treatment modality (P < 0.001), ranging from a median of 382 days in those treated with a combination of craniotomy, radiotherapy (RT), and temozolomide (TZM), to 43 days in those only receiving a burr hole biopsy with no further treatment. On multivariable analysis, treatment with RT + TZM was significantly independently associated with longer patient survival (P < 0.001). Craniotomy was associated with a significant improvement in performance status, compared to burr hole biopsy (P = 0.006). For the subgroup of patients receiving TZM, those with a methylated O6-methylguanine-DNA-methyltransferase (MGMT) status had significantly longer overall survival than those with unmethylated MGMT (median: 407 vs. 341 days, P = 0.039). Conclusion: Our retrospective data demonstrate that the elderly population with GB benefit from aggressive chemo-RT, regardless of surgical intervention.
The impact of Covid-19 on surgical patients worldwide has been substantial. In the United Kingdom (UK) and the Republic of Ireland (RoI), the first wave of the pandemic occurred in March 2020. The aims of this study were to: (1) evaluate the volume of neurosurgical operative activity levels, Covid-19 infection rate and mortality rate in April 2020 with a retrospective cross-sectional cohort study conducted across 16 UK and RoI neurosurgical centres, and (2) compare patient outcomes in a single institution in April-June 2020 with a comparative cohort in 2019. Across the UK and RoI, 818 patients were included. There were 594 emergency and 224 elective operations. The incidence rate of Covid-19 infection was 2.6% (21/818). The overall mortality rate in patients with a Covid-19 infection was 28.6% (6/21). In the single centre cohort analysis, an overall reduction in neurosurgical operative activity by 65% was observed between 2020 (n = 304) and 2019 (n = 868). The current and future impact on UK neurosurgical operative activity has implications for service delivery and neurosurgical training.
