Multiple Microsurgical Resections for Repeated Recurrence of Glioblastoma Multiforme

Hong, Bujung; Wiese, Bettina S.; Bremer, Michael; Heissler, Hans E.; Heidenreich, Fedor; Krauss, Joachim K.; Nakamura, Makoto

doi:10.1097/coc.0b013e3182467bb1

Cited by 46 publications

(21 citation statements)

References 66 publications

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“…Repeat resection for recurrent GBM has been shown to increase quality of life as well as length of survival. 1,6 However, Gorlia et al 3 (2012) show that performance status is the major prognostic factor when determining overall survival and progressionfree survival in patients with recurrent GBM.…”

Section: Discussionmentioning

confidence: 99%

“…9 Likewise, the goal at repeat resection is the same-to achieve as extensive a resection as possible to decrease tumor burden, thereby improving overall patient survival time as well as quality of life. 1,6 Although MRI is the standard method of preoperative tumor detection, MRI alone may not be able to completely visualize the full extent of diffuse infiltrative glial tumors. In cases where there is a concern for diffuse tumor spread, supplemental techniques for tumor detection such as intraoperative 5-aminolevulinic acid (5-ALA) may be helpful in linking the recurrence to the primary site.…”

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confidence: 99%

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Subependymal spread of recurrent glioblastoma detected with the intraoperative use of 5-aminolevulinic acid

Cage

Pekmezci

Prados

et al. 2013

JNS

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Recurrent glioblastoma (GBM) can occur locally or at distant sites within the brain. Though MRI is the standard imaging modality for primary and recurrent GBM, the full extent of diffuse lesions may not be appreciated on MRI alone. Glioblastomas with ependymal and/or subependymal spread are examples of diffuse infiltrative tumors that are incompletely seen on MRI. Some other adjuvant visualization technique such as intraoperative fluorescence-assisted 5-aminolevulinic acid (5-ALA) could be used to assist the surgeon in localizing the infiltrating tumor. The authors report on a 56-year-old man who presented 7 years after initial resection of an occipital lobe GBM with imaging consistent with distant discrete foci of tumor recurrence. Because these foci were distant from the original resection cavity, there was concern for diffuse, infiltrative tumor elsewhere throughout the brain versus a distant multicentric recurrence. Therefore, the patient was given 5-ALA prior to surgery to aid in tumor detection intraoperatively. Using fluorescent visualization of the resection cavity, it was confirmed that there was subependymal and ependymal spread of the recurrent tumor along the lateral ventricle connecting the recurrence to the previous tumor site. Magnetic resonance imaging may not completely detect the presence of diffuse tumor infiltrating the ependymal or subependymal spaces. Therefore, adjunct intraoperative use of fluorescence-assisted visualization with 5-ALA may be helpful in highlighting and detecting infiltrative tumor to accurately detect tumor burden and distinguish it from a separate multicentric recurrence.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Subependymal spread of recurrent glioblastoma detected with the intraoperative use of 5-aminolevulinic acid

Cage

Pekmezci

Prados

et al. 2013

JNS

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“…Several retrospective Level of Evidence III-IV studies 74 support repeat tumor resections, as long as the patient's performance status is not low and preoperative tumor volume is not excessive. 1,5,16,26,30,55 A randomized, double-blind, placebo-controlled control trial also supported the implantation of carmustine (BCNU) wafers in tumor cavities after repeat operation. 10 Although salvage temozolomide had previously been used for recurrent GBM, 9,56,80 recent Level II evidence clinical studies in patients with recurrent GBM have demonstrated that salvage chemotherapy combining bevacizumab, an antiangiogenic agent, with cytotoxic drugs can extend progression-free survival and overall survival to 6.1 and 9.2 months, respectively.…”

Section: Treatment Of Recurrent Hggsmentioning

confidence: 99%

“…76 In select patients, salvage chemotherapy for recurrent HGGs is optimally preceded by repeat resection. 1,5,16,26,30,55,74,81 However, for a range of reasons, there are subsets of patients who are not ideal candidates for traditional open surgery, and many patients decline open surgery due to associated morbidity. For these patients, LITT has been considered a reasonable option for many reasons (Fig.…”

Section: Treatment Of Recurrent Hggsmentioning

confidence: 99%

Stereotactic laser ablation of high-grade gliomas

Hawasli¹,

Kim

Dunn

et al. 2014

FOC

110

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Evolving research has demonstrated that surgical cytoreduction of a high-grade glial neoplasm is an important factor in improving the prognosis of these difficult tumors. Recent advances in intraoperative imaging have spurred the use of stereotactic laser ablation (laser interstitial thermal therapy [LITT]) for intracranial lesions. Among other targets, laser ablation has been used in the focal treatment of high-grade gliomas (HGGs). The revived application of laser ablation for gliomas parallels major advancements in intraoperative adjuvants and groundbreaking molecular advances in neuro-oncology. The authors review the research on stereotactic LITT for the treatment of HGGs and provide a potential management algorithm for HGGs that incorporates LITT in clinical practice.

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“…In spite of the advances in microsurgery to accomplish optimized resections (extensive, without worsening of the neurologic function), followed by standard treatment with concomitant radiotherapy (RT) and chemotherapy (CT) and maintenance therapy with temozolomide (TMZ) 2 , the patients' survival remains rather limited, with small survival gains obtained in recent years 3,4,5 . The main factors associated with patient survival are age and functional status before surgery 6,7 ; the extent of resection 7,8 , adjuvant treatment 7,9 and methylation of the O6-methylguanine-DNA methyltransferase (MGMT) promoter 10 , which also seem to be associated with increased survival. The role of surgical treatment for recurrence or regrowth of GBM has not yet been fully established.…”

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confidence: 99%

Performance of adjuvant treatment correlates with survival in reoperated glioblastomas

Zanovello

Malheiros

Stávale

et al. 2016

Arq. Neuro-Psiquiatr.

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Objective To analyze cases of recurrent glioblastoma subjected to reoperation at a Brazilian public healthcare service. Methods A total of 39 patients subjected to reoperation for recurrent glioblastoma at the Department of Neurosurgery, São Paulo Hospital, Federal University of São Paulo, from January 2000 to December 2013 were retrospectively analyzed. Results The median overall survival was 20 months (95% confidence interval – CI = 14.9–25.2), and the median survival after reoperation was 9.1 months (95%CI: 2.8–15.4). The performance of adjuvant treatment after the first operation was the single factor associated with overall survival on multivariate analysis (relative risk – RR = 0.3; 95%CI = 0.2–0.7); p = 0.005). Conclusion The length of survival of patients subjected to reoperation for glioblastoma at a Brazilian public healthcare service was similar to the length reported in the literature. Reoperation should be considered as a therapeutic option for selected patients.

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Multiple Microsurgical Resections for Repeated Recurrence of Glioblastoma Multiforme

Abstract: Microsurgical resection of repeatedly recurring GBM is likely to prolong survival. Repeated surgical resection may be considered as an effective treatment option in addition to radiochemotherapy in repeated GBM recurrence.

Cited by 46 publications

References 66 publications

Subependymal spread of recurrent glioblastoma detected with the intraoperative use of 5-aminolevulinic acid

Subependymal spread of recurrent glioblastoma detected with the intraoperative use of 5-aminolevulinic acid

Stereotactic laser ablation of high-grade gliomas

Performance of adjuvant treatment correlates with survival in reoperated glioblastomas

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