P21.08 Stereotactic biopsy in elderly patients: risk assessment and impact on treatment decision

Abstract

AbstractObjective:To evaluate feasibility and risk profile of stereotactic biopsy (SB) in elderly patients and to analyse its impact upon treatment decision.Methods:In this single center retrospective analysis we identified all patients aged ≥70 years receiving SB in a defined period between January 2005 and December 2015. We documented age, gender, Karnofsky Performance Status (KPS), histology, co-morbidity (by CHA2DS2-VASc Score) and use of anticoagulation. We then scrutinized feasibility, diagnostic yield, procedural complications (mortality, transient and permanent morbidity), time as an in-patient and the overall therapeutic consequence. For correlational analysis regarding outcome Chi-Square, Mann-Whitney rank sum test and binary regression were used.Results:Two hundred and thirty patients were included. In 229 patients SB was successfully performed. Median age was 74 (70–87) years, gender distribution was male in 56.1% and median preoperative KPS was 80 (30–100). Pathological diagnosis was conclusive in 96.1% revealing neoplastic lesions in 91.7% (high-grade glioma 62.6%, lymphoma 18.3%, metastasis 4.8%, low-grade glioma 3.0% and other tumors 3.0%) and non-neoplastic lesions in 4.4%. Median CHA2DS2-VASc Score was 4 (1–9); 29.6% received anticoagulation and median stay as an inpatient was 8 (2–29) days.Procedure-related mortality was 0.4%, transient morbidity was seen in 19 patients (8.3%) and permanent morbidity in eight patients (3.5%; aggravation of preoperative symptoms (n=7); decreased level of consciousness (n=1)). Adjuvant disease specific therapy was initiated in 171/230 (74.3%) patients.Complication rate was not associated with any above-mentioned parameters. Decision against disease-specific therapy was not influenced by age but only by preoperative KPS <70 (p<0.001).Conclusion:These data demonstrate that stereotactic biopsy in elderly patients is feasible, safe and offers a high diagnostic yield. Thus, it can be offered to elderly patients ≥ 70 years in an independent functional status (KPS≥70) with unclear cerebral lesions to submit disease specific therapy irrespective of localization, medical history or anticoagulant medication.