Reoperation for malignant astrocytomas: Personal experience and a review of the literature

Strömblad, Lars-Göran; Anderson, Harald; Malmström, Per; Salford, Leif G.

doi:10.3109/02688699308995091

Cited by 24 publications

(10 citation statements)

References 27 publications

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“…Wallner et al 32 15.4% morbidity Dirks et al 18 4.6% mortality 9.3% morbidity (wound infections) Strö mblad et al 39 2% mortality at 1 mo 5% morbidity (postoperative complications) Clark et al 17 35% wound healing complication rate after the use of preoperative bevacizumab before craniotomy efficacy in recurrent high-grade glioma. 38 Patients receiving antivascular endothelial growth factor therapy before and after reoperation were studied by Clark et al 16 Of all patients receiving a reoperation at the time of tumor recurrence, 35% had been treated with preoperative bevacizumab, and 10% received no bevacizumab therapy.…”

Section: Complications Of Reoperationmentioning

confidence: 99%

“…Although the preponderance of studies indicates a survival benefit with reoperation for recurrent high-grade glioma, favorable outcomes have not always been reported in the literature (Table 5). Stromblad et al 39 published the results of a randomized trial comparing chemotherapy alone and chemotherapy plus radiotherapy for patients with recurrent high-grade glioma. EOR was not volumetrically assessed.…”

Section: Studies Not Supporting Reoperationmentioning

confidence: 99%

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Reoperation for Recurrent High-Grade Glioma

Hervey-Jumper

Berger

2014

Neurosurgery

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Optimal treatment for recurrent high-grade glioma continues to evolve. Currently, however, there is no consensus in the literature on the role of reoperation in the management of these patients. In this analysis, we reviewed the literature to examine the role of reoperation in patients with World Health Organization grade III or IV recurrent gliomas, focusing on how reoperation affects outcome, perioperative complications, and quality of life. An extensive literature review was performed through the use of the PubMed and Ovid Medline databases for January 1980 through August 2013. A total 31 studies were included in the final analysis. Of the 31 studies with significant data from single or multiple institutions, 29 demonstrated a survival benefit or improved functional status after reoperation for recurrent high-grade glioma. Indications for reoperation included new focal neurological deficits, tumor mass effect, signs of elevated intracranial pressure, headaches, increased seizure frequency, and radiographic evidence of tumor progression. Age was not a contraindication to reoperation. Time interval of at least 6 months between operations and favorable performance status (Karnofsky Performance Status score ≥70) were important predictors of benefit from reoperation. Extent of resection at reoperation improved survival, even in patients with subtotal resection at initial operation. Careful patient selection such as avoiding those individuals with poor performance status and bevacizumab within 4 weeks of surgery is important. Although limited to retrospective analysis and patient selection bias, mounting evidence suggests a survival benefit in patients receiving a reoperation at the time of high-grade glioma recurrence.

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Section: Complications Of Reoperationmentioning

confidence: 99%

Section: Studies Not Supporting Reoperationmentioning

confidence: 99%

Reoperation for Recurrent High-Grade Glioma

Hervey-Jumper

Berger

2014

Neurosurgery

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“…In these cases, re-operation seems to be the last therapeutic option. Nevertheless, the existing studies on the question, if re-operation is useful could not answer this question [1,2,3,5,9,14,18,20,21,23,24,25,26]. In addition there are only a few studies available considering re-operation on patients with recurrent glioblastoma multiforme alone [5,6,9,26].…”

Section: Discussionmentioning

confidence: 99%

Experiences with reoperation on recurrent glioblastoma multiforme

Pinsker¹,

Lumenta²

2002

Zentralbl Neurochir

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“…If we limit our inclusion criteria to only prospective data, we would conclude that reoperation can prolong time to progression, [9] which implies better quality of life, but the effect on overall patient survival time is not clear. [9,10,12] Unfortunately, even the prospective studies are questionable on the issue of reoperation alone, because none was specifically designed to address this issue in isolation. Adding the Class III studies would allow us to also suggest that patients either maintain their current performance or improve following a second procedure.…”

Section: Discussionmentioning

confidence: 99%

“…[3,16] Overall, the authors of one Class II [10] and 10 Class III studies [2][3][4][6][7][8][11][12][13][14]16] suggest that operation for recurrent tumor benefits the patient, either through prolonged survival when compared with historical controls or in delaying the time to progression. However, results from two Class II [9,12] and one Class III [5] articles were unable to demonstrate a survival advantage when compared with similar patients controlled for KPS scores and age or by using multivariate analysis. All of the studies are biased by uncontrolled patient selection, leaving us to conclude that although there is evidence to support the role of reoperation in selected patients, this evidence at best can provide a treatment option.…”

Section: Discussionmentioning

confidence: 99%

Evidence-based review of the role of reoperation in the management of malignant glioma

Soults

Canute

Ryken³

1998

FOC

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Using an evidence-based approach to available clinical studies, the authors examined the role of reoperation in the management of malignant glioma. A review of 1270 Medline-referenced articles spanning the period from 1966 through March 1998 was undertaken using the key words “glioblastoma” and “astrocytoma.” Using an evidence-based four-tiered grading system, the authors found only 14 articles that met their inclusion criteria. Of these, 11 were graded as Class III (retrospective case series) and three as Class II (prospective nonrandomized studies). There were no Class I reports (randomized clinical trials), and all Class IV reports (opinion reports) were excluded. The authors of 10 Class III and one Class II articles supported the role of reoperation in increasing survival time or quality of life in selected patients; however, the results of multivariate analysis in two Class II and one Class III article did not support prolonged survival. The authors conclude that there was insufficient evidence to support either a standard or a guideline for reoperation in malignant glioma given the current status of the literature. Selection bias was a major factor in these studies. With continued interest in clinical trials for recurrent malignant glioma, the role of reoperation needs to be addressed in case-controlled or randomized fashion to establish either standards or guidelines on this commonly debated issue.

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Reoperation for malignant astrocytomas: Personal experience and a review of the literature

Cited by 24 publications

References 27 publications

Reoperation for Recurrent High-Grade Glioma

Reoperation for Recurrent High-Grade Glioma

Experiences with reoperation on recurrent glioblastoma multiforme

Evidence-based review of the role of reoperation in the management of malignant glioma

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