Repeat-surgery at Glioblastoma recurrence, when and why to operate?

Ening, Genevieve; Huynh, Mai Thi; Schmieder, Kirsten; Brenke, Christopher

doi:10.1016/j.clineuro.2015.05.024

Cited by 21 publications

(19 citation statements)

References 26 publications

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“…In the literature, not much is present on the topic, with the majority of the articles focusing on HGGs owing to their high recurrence rates [ 22 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Concerning the oncological benefit, the current literature indicates improved survival time in carefully selected patients undergoing repeated surgery [ 22 , 23 , 28 – 30 ]. Concerning the risks, Chang et al found that there was a modest trend toward increased perioperative complications among patients undergoing repeated craniotomy, despite similar length of surgery [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

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Repeated craniotomies for intracranial tumors: is the risk increased? Pooled analysis of two prospective, institutional registries of complications and outcomes

et al. 2018

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Purpose Deciding whether to re-operate patients with intracranial tumor recurrence or remnant is challenging, as the data on safety of repeated procedures is limited. This study set out to evaluate the risks for morbidity, mortality, and complications after repeated operations, and to compare those to primary operations. Methods Retrospective observational two-center study on consecutive patients undergoing microsurgical tumor resection. The data derived from independent, prospective institutional registries. The primary endpoint was morbidity at 3 months (M3), defined as significant decrease on the Karnofsky Performance Scale (KPS). Secondary endpoints were mortality, rate and severity of complications according to the Clavien–Dindo Grade (CDG). Results 463/2403 (19.3%) were repeated procedures. Morbidity at M3 occurred in n = 290 patients (12.1%). In univariable analysis, patients undergoing repeated surgery were 98% as likely as patients undergoing primary surgery to experience morbidity (OR 0.98, 95% CI 0.72–1.34, p = 0.889). In multivariable analysis adjusted for age, sex, tumor size, histology and posterior fossa location, the relationship remained stable (aOR 1.25, 95% CI 0.90–1.73, p = 0.186). Mortality was n = 10 (0.4%) at discharge and n = 95 (4.0%) at M3, without group differences. At least one complication occurred in n = 855, and the rate (35.5% vs. 35.9%, p = 0.892) and severity (CDG; p = 0.520) was similar after primary and repeated procedures. Results were reproduced in subgroup analyses for meningiomas, gliomas and cerebral metastases. Conclusions Repeated surgery for intracranial tumors does not increase the risk of morbidity. Mortality, and both the rate and severity of complications are comparable to primary operations. This information is of value for patient counseling and the informed consent process. Electronic supplementary material The online version of this article (10.1007/s11060-018-03058-y) contains supplementary material, which is available to authorized users.

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“…In the literature, not much is present on the topic, with the majority of the articles focusing on HGGs owing to their high recurrence rates [ 22 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Repeated craniotomies for intracranial tumors: is the risk increased? Pooled analysis of two prospective, institutional registries of complications and outcomes

et al. 2018

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“…Previously published studies could show a signi cant correlation between the preoperative KPS score and the outcome after glioma surgery [4,15]. In most studies, only patients suffering from a glioblastoma with a KPSS of ≥ 70% were included [19,6]. For example, those studies analysed prognostic factors such as tumour size, GRT and adjuvant therapy modalities postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Do Patients with a Poor Karnofsky Performance Status Scale Profit from Tumour Volume Reduction?

Barz¹,

J²,

Bette³

et al. 2020

Preprint

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Purpose: Median overall survival (OS) after diagnosis of glioblastoma (GBM) remains 15 months amongst patients receiving aggressive surgical resection, chemotherapy and irradiation. Treatment of patients with a poor preoperative Karnofsky Performance Status Scale (KPSS) is still controversial. Therefore, we retrospectively assessed the outcome after surgical treatment in patients with a KPSS of ≤ 60%.Methods: We retrospectively included patients with a de-novo glioblastoma WHO °IV and preoperative KPSS ≤ 60%, who underwent surgery at two neurosurgical centres between September 2006 and March 2016. We recorded pre- and postoperative tumour volume, pre- and postoperative KPSS, OS, age and MGMT promoter status.Results: 123 patients (58 females/65 males, mean age 67.4 ± 13.4 years) met the inclusion criteria. 75 of the 123 patients (61%) underwent surgical resection. 48/123 patients (39%) received a biopsy. The median preoperative and postoperative tumour volume of all patients was 33.0 ± 31.3 cm3 (IR 15.0–56.5cm3) and 3.1 ± 23.8 cm3 (IR 0.2–15.0 cm3), respectively. The median KPSS was 60% (range 20–60%) preoperatively and 50% (range 0–80%) postoperatively. The median OS was 123 ± 220 days (IR 52–395 days). Age (p<0.001, HR: 1.045 [95% CI 1.022–1.068]), postoperative tumour volume (p=0.02, HR: 1.016 [95% CI 1.002–1.029]) and MGMT promotor status (p=0.016, HR: 0.473 [95% CI 0.257–0.871]) were statistically significant in multivariate analysis.Conclusion: Patients with a preoperative KPSS of ≤ 60% benefit from low postoperative residual tumour volumes. Age and MGMT-methylation status were also significant prognostic parameters in this patient cohort.

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“…The longest reported survival terms, despite aggressive therapy, are lower than two years. [3][4][5][6][7][8][9] Aggressive therapies, including surgery, chemotherapy and radiation are not only costly, but bear additional complications. [10][11][12] Nearly all patients with GBM have a poor quality of life, and health related quality of life (HRQoL) is defined as a multidimensional concept covering physical, psychological, and social domains, as well as symptoms induced by the disease and its treatment.…”

Section: Introductionmentioning

confidence: 99%

Glioblastoma Multiforme: an Advanced Analysis of 153 Patients and Review of the Literature

et al. 2017

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Objective Glioblastoma multiforme (GBM) is an aggressive primary tumor with frequent recurrences that leaves patients with a short survival time and a low quality of life. The aim of this study was to review the prognostic factors in patients with glioblastoma multiforme. Material and Methods The focus of this retrospective study was a group of 153 patients with supratentorial GBM tumors, who were admitted to a tertiary-care referral academic center from 2005 to 2013. The factors associated with survival and local recurrence were assessed using the hazard ratio (HR) function of Cox proportional hazards regression and neural network analysis. Results Out of the 153 patients, 99 (64.7%) were male. The average age of the patients was 55.69 AE 15.10 years. The median overall survival (OS) and progression-free survival (PFS) rates were 14.0 and 7.10 months respectively. In the multivariate analysis, age (HR ¼ 2.939, p < 0.001), operative method (HR ¼ 7.416, p < 0.001), temozolomide (TMZ, HR ¼ 11.723, p < 0.001), lomustine (CCNU, HR ¼ 8.139, p < 0.001), occipital lobe involvement (HR ¼ 3.088, p < 0.001) and Karnofsky Performance Status (KPS, HR ¼ 4.831, p < 0.001) scores were shown to be significantly associated with a higher OS rate. Furthermore, higher KPS (HR ¼ 7.292, p < 0.001) readings, the operative method (HR ¼ 0.493, p ¼ 0.005), the use of CCNU (HR ¼ 2.047, p ¼ 0.003) and resection versus chemotherapy (HR ¼ 0.171, p < 0.001) were the significant factors associated with the local recurrence of the tumor. Conclusion Our findings suggest that the use of CCNU and TMZ, the operative method and higher KPS readings are associated with both higher survival and lower local recurrence rates.

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Repeat-surgery at Glioblastoma recurrence, when and why to operate?

Cited by 21 publications

References 26 publications

Repeated craniotomies for intracranial tumors: is the risk increased? Pooled analysis of two prospective, institutional registries of complications and outcomes

Repeated craniotomies for intracranial tumors: is the risk increased? Pooled analysis of two prospective, institutional registries of complications and outcomes

Do Patients with a Poor Karnofsky Performance Status Scale Profit from Tumour Volume Reduction?

Glioblastoma Multiforme: an Advanced Analysis of 153 Patients and Review of the Literature

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