A practical scoring system to determine whether to proceed with surgical resection in recurrent glioblastoma

Park, Shin Young; Kim, Jeong Hoon; Nam, Do Hyun; Kim, Chae Yong; Chung, Sang Bong; Kim, Young Hoon; Seol, Ho Jun; Kim, Tae Min; Choi, Seung Hong; Lee, Se‐Hoon; Heo, Dae Seog; Kim, Il Han; Kim, Dong Gyu; Jung, Hee Won

doi:10.1093/neuonc/not069

Cited by 70 publications

(35 citation statements)

References 20 publications

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“…An alternative scoring system has also been introduced, which includes the unfavorable variable of ependymal involvement. 20 However, rates of complications are significantly higher (27% vs 13%) in second resections compared with the first resections, with an increased risk of infection and poor wound healing, and worse postoperative functional and neurological outcomes. 4,9 Recurrences often occur at the edges of resection that border on eloquent regions.…”

Section: Discussionmentioning

confidence: 99%

Laser interstitial thermal therapy for newly diagnosed and recurrent glioblastoma

Thomas

Rao

Kew

et al. 2016

FOC

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OBJECTIVE Glioblastoma (GBM) is the most common and deadly malignant primary brain tumor. Better surgical therapies are needed for newly diagnosed GBMs that are difficult to resect and for GBMs that recur despite standard therapies. The authors reviewed their institutional experience of using laser interstitial thermal therapy (LITT) for the treatment of newly diagnosed or recurrent GBMs. METHODS This study reports on the pre-LITT characteristics and post-LITT outcomes of 8 patients with newly diagnosed GBMs and 13 patients with recurrent GBM who underwent LITT. RESULTS Compared with the group with recurrent GBMs, the patients with newly diagnosed GBMs who underwent LITT tended to be older (60.8 vs 48.9 years), harbored larger tumors (22.4 vs 14.6 cm3), and a greater proportion had IDH wild-type GBMs. In the newly diagnosed GBM group, the median progression-free survival and the median survival after the procedure were 2 months and 8 months, respectively, and no patient demonstrated radiographic shrinkage of the tumor on follow-up imaging. In the 13 patients with recurrent GBM, 5 demonstrated a response to LITT, with radiographic shrinkage of the tumor following ablation. The median progression-free survival was 5 months, and the median survival was greater than 7 months. CONCLUSIONS In carefully selected patients with recurrent GBM, LITT may be an effective alternative to surgery as a salvage treatment. Its role in the treatment of newly diagnosed unresectable GBMs is not established yet and requires further study.

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Section: Discussionmentioning

confidence: 99%

Laser interstitial thermal therapy for newly diagnosed and recurrent glioblastoma

Thomas

Rao

Kew

et al. 2016

FOC

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“…Factors proposed for benefit of surgery and decision-making represent general prognostic factors for glioblastoma, such as age, MGMT promotor methylation, performance status, tumor volume, extent of resection, and tumor localization. A scale including tumor involvement in non-eloquent areas, small tumor volume (< 50 cm 3 ) and good performance status (KPS>80%) was proposed in 2010 and modified to a score comprising KPS and ependymal involvement for decision making regarding reoperation, based on retrospective data [26,27].…”

Section: Surgery At Recurrencementioning

confidence: 99%

Therapeutic options in recurrent glioblastoma—An update

Seystahl

Wick

Weller

2016

Critical Reviews in Oncology/Hematology

177

134

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“…The scale identified three statistically distinct groups within the validation cohort as well (median survival of 9.2, 6.3, and 1.9 months, respectively) (76). Recently, a new 3-tier scale was developed, including KPS score of 70 and ependymal involvement, allowing identification of groups of patients with significant differences in median OS after reoperation (79). Maximal tumor volume resection should be the surgical goal even in candidates for a second surgery.…”

Section: Surgery At Recurrencementioning

confidence: 99%

Current Standards of Care in Glioblastoma Therapy

et al. 2017

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Glioblastoma (GBM) is the most common primary malignant brain tumor in adults. Regardless of ideal multidisciplinary treatment, including maximal surgical resection, followed by radiotherapy plus concomitant and maintenance temozolomide (TMZ), almost all patients experience tumor progression with nearly universal mortality and a median survival of less than 15 months. The addition of bevacizumab to standard treatment with TMZ revealed no increase in overall survival (OS) but improved progression-free survival (PFS). In newly diagnosed GBM, methylation of the O6-methylguanine-DNA methyltransferase (MGMT) promoter has been shown to predict response to alkylating agents, as well asgnosis. Therefore, MGMT promoter status may have a crucial role in the choice of single modality treatment in fragile elderly population. No standard of care is established in recurrent or progressive GBM. Treatment alternatives may include supportive care, surgery, re-irradiation, systemic therapies, and combined modality therapy. Despite numerous clinical trials, the identification of effective therapies is complex because of the lack of appropriate control arms, selection bias, small sample sizes, and disease heterogeneity. Tumor-treating fields plus TMZ represent a major advance in the field of GBM therapy, and should be Standards of Care in Glioblastoma Therapy 198 considered for patients with newly diagnosed GBM with no contraindications. As a disease with such a poor prognosis, treatment of GBM should go beyond improving survival and aim at preserving and even improving the quality of life of both the patient and the caregiver.

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A practical scoring system to determine whether to proceed with surgical resection in recurrent glioblastoma

Abstract: We developed a practical scale to facilitate deciding whether to proceed with surgical management in patients with recurrent glioblastoma. This scale was useful for the diagnosis of prognostic groups and can be used to develop guidelines for patient treatment.

Cited by 70 publications

References 20 publications

Laser interstitial thermal therapy for newly diagnosed and recurrent glioblastoma

Laser interstitial thermal therapy for newly diagnosed and recurrent glioblastoma

Therapeutic options in recurrent glioblastoma—An update

Current Standards of Care in Glioblastoma Therapy

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