Reoperation for recurrent glioblastomas: What to expect?

Abstract

Background: The current standard treatment for glioblastoma (GBM) is maximal safe surgical resection followed by radiation and chemotherapy. Unfortunately, the disease will invariably recur even with the best treatment. Although the literature suggests some advantages in reoperating patients harboring GBM, controversy remains. Here, we asked whether reoperation is an efficacious treatment strategy for GBM, and under which circumstances, it confers a better prognosis. Methods: We retrospectively reviewed 286 consecutive cases of newly diagnosed GBM in a single university hospital from 2008 to 2015. We evaluated clinical and epidemiological parameters possibly influencing overall survival (OS) by multivariate Cox regression analysis. OS was calculated using the Kaplan–Meier method in patients submitted to one or two surgical procedures. Finally, the survival curves were fitted with the Weibull model, and survival rates at 6, 12, and 24 months were estimated. Results: The reoperated group survived significantly longer (n = 63, OS = 20.0 ± 2.3 vs. 11.4 ± 1.0 months, P < 0.0001). Second, the multivariate analysis revealed an association between survival and number of surgeries, initial Karnofsky Performance Status, and age (all P < 0.001). Survival estimates according to the Weibull regression model revealed higher survival probabilities for reoperation compared with one operation at 6 months (83.74 ± 3.42 vs. 63.56 ± 3.59, respectively), 12 months (64.00 ± 4.85 vs. 37.53 ± 3.52), and 24 months (32.53 ± 4.78 vs. 12.02 ± 2.36). Conclusion: Our data support the indication of reoperation for GBM, especially for younger patients with good functional status. Under these circumstances, survival can be doubled at 12 and 24 months.

Recurrent Glioblastoma—Molecular Underpinnings and Evolving Treatment Paradigms

“…The authors reported that repeat surgery resulted in improved OS in the younger group. Neville et al [127] reported similar findings in a group of 286 patients who had adjuvant carmustine or TMZ. OS at 6, 12, and 24 months was greater for patients who also underwent reoperation for recurrent glioblastoma [127].…”

“…Neville et al [127] reported similar findings in a group of 286 patients who had adjuvant carmustine or TMZ. OS at 6, 12, and 24 months was greater for patients who also underwent reoperation for recurrent glioblastoma [127]. However, OS was confounded by younger age, higher KPS, the type of initial management, and reoperation extent.…”

PVA-Microbubbles as a Radioembolization Platform: Formulation and the In Vitro Proof of Concept

“…Glioblastoma multiforme (GBM) is the most common primary malignancy of the central nervous system, and it still represents an unsolved clinical problem with a median life expectancy of 15 months and an overall survival rate of 6.8% for patients at 5 years [ 1 ]. Surgical resection, followed by chemo-radiotherapy and adjuvant chemotherapy, represents the standard of care [ 2 ], but in patients with recurrent GBM, reoperation and second-line chemotherapy are critical and mostly suboptimal [ 3 ]. Furthermore, in the case of re-irradiation of the tumor mass, higher doses are needed to treat radioresistant GBM [ 4 ].…”

Does Combined Fractionated Stereotactic Radiotherapy and Immunotherapy Change the Outcome of Recurrent High-Grade Gliomas?

“…Despite advances in treatment, the recurrence rate is still high in high-grade gliomas. After recurrence, although not always possible, a second surgery is preferred with increased survival rates [5]. Salvage re-irradiation increases OS and progression-free survival (PFS) rates in GB [6][7][8].…”