Usefulness of Reintervention in Recurrent Glioblastoma: An Indispensable Weapon for Increasing Survival

Delgado-Fernández, Juan; García-Pallero, María A.; Blasco, Guillermo; Penanes, Juan R.; Gil-Simoes, Ricardo; Pulido, Paloma Contreras; Sola, Rafael G.

doi:10.1016/j.wneu.2017.09.062

Cited by 30 publications

(21 citation statements)

References 26 publications

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“…Given the sparse number of studies with time-dependent analyses, more evidence was needed to demonstrate the estimate bias occurring in survival analysis, where a time-varying covariate is treated as a time-fixed one. The survival data of the three included studies (12, 15, 25) were reanalyzed by the traditional Kaplan-Meier method, landmark method and Simon-Makuch method. Traditional Kaplan-Meier curves showed that patients with reoperation had prolonged OS compared with those without reoperation (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

“…Survival curve plotted by the Kaplan-Meier and landmark methods. The survival data from the studies of Woernle et al (25) (A) , Zanello et al (15) (B) , and Delgado-Fernandez et al (12) (C) were reanalyzed by the Kaplan-Meier (left) and landmark methods (middle and right). The Kaplan-Meier curve started at the initial diagnosis (left), and the landmark curve started at the 50th percentile (middle) and 75th percentile (right) of time between first and second surgery.…”

Section: Resultsmentioning

confidence: 99%

“…To illustrate the estimate bias that occurs when a time-dependent covariate is treated as known at the start of the study, the survival curves of three included studies (12, 15, 25), in which reoperation was considered as a fixed covariate in the multivariate Cox model, were plotted and reanalyzed by three methods. The traditional Kaplan-Meier method treats the covariate as a fixed value at the start of the study.…”

Section: Methodsmentioning

confidence: 99%

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A Meta-Analysis of Survival Outcomes Following Reoperation in Recurrent Glioblastoma: Time to Consider the Timing of Reoperation

et al. 2019

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Background: Glioblastoma multiforme (GBM) inevitably recurs, but no standard regimen has been established for recurrent patients. Reoperation at recurrence alleviates mass effects, and the survival benefit has been reported in many studies. However, in most studies, the effect of reoperation timing on survival benefit was ignored. The aim of this meta-analysis was to investigate whether reoperation provided similar survival benefits in recurrent GBM patients when it was analyzed as a fixed or time-dependent covariate. Methods: A systematic literature search of PubMed, EMBASE, and Cochrane databases was performed to identify original articles that evaluated the associations between reoperation and prognosis in recurrent GBM patients. Results: Twenty-one articles involving 8,630 patients were included. When reoperation was considered as a fixed covariate, it was associated with better overall survival (OS) and post-progression survival (PPS) (OS: HR = 0.66, 95% CI 0.61-0.71, p < 0.001, I 2 = 0%; PPS: HR = 0.70, 95% CI 0.57–0.88, p < 0.01, I 2 = 70.2%). However, such a survival benefit was not observed when reoperation was considered as a time-dependent covariate (OS: HR = 2.19, 95% CI 1.47–3.27, p < 0.001; PPS: HR = 0.95, 95% CI 0.82–1.10, p = 0.51, I 2 = 0%). The estimate bias caused by ignoring the time-dependent nature of reoperation was further demonstrated by the re-analysis of survival data in three included studies. Conclusions: The timing of reoperation may have an impact on the survival outcome in recurrent GBM patients, and survival benefits of reoperation in recurrent GBM may be overestimated when analyzed as fixed covariates. Proper analysis methodology should be used in future work to confirm the clinical benefits of reoperation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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A Meta-Analysis of Survival Outcomes Following Reoperation in Recurrent Glioblastoma: Time to Consider the Timing of Reoperation

et al. 2019

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“…As survival after brain tumor surgery increases [ 18 , 19 , 20 , 21 ], so too does the role for rehabilitation in these patients [ 6 ]. There is strong evidence to support multidisciplinary rehabilitation for other neurological and oncological conditions but relatively little data on rehabilitation following brain tumor treatment [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Functional State and Motor Skills of Patients after Cerebral Hemisphere, Ventricular System, and Cerebellopontine Angle Tumor Surgery

Krajewski

Furtak²,

Zawadka‐Kunikowska

et al. 2022

IJERPH

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Brain tumor location is an important factor determining the functional state after brain tumor surgery. We assessed the functional state and course of rehabilitation of patients undergoing surgery for brain tumors and assessed the location-dependent risk of loss of basic motor skills and the time needed for improvement after surgery. There were 835 patients who underwent operations, and 139 (16.6%) required rehabilitation during the inpatient stay. Karnofsky Performance Scale, Barthel Index, and the modified Rankin scale were used to assess functional status, whereas Gait Index was used to assess gait efficiency. Motor skills, overall length of stay (LOS) in hospital, and LOS after surgery were recorded. Patients were classified into four groups: cerebral hemisphere (CH), ventricular system (VS), and cerebellopontine angle (CPA) tumors; and a control group not requiring rehabilitation. VS tumor patients had the lowest scores in all domains compared with the other groups before surgery (p < 0.001). Their performance further deteriorated after surgery and by the day of discharge. They most often required long-lasting postoperative rehabilitation and had the longest LOS (35 days). Operation was most often required for CH tumors (77.7%), and all metrics and LOS parameters were better in these patients (p < 0.001). Patients with CPA tumors had the best outcomes (p < 0.001). Most patients (83.4%) with brain tumors did not require specialized rehabilitation, and LOS after surgery in the control group was on average 5.1 days after surgery. VS tumor patients represent a rehabilitation challenge. Postoperative rehabilitation planning must take the tumor site and preoperative condition into account.

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“…The very few studies that address this question usually compare cohorts generated from a single institution after certain selection criteria are met (based on competing comorbidities, performance status, or resectability of the tumor at baseline) or compare cohorts from before and after the Stupp era. 5,14,15,20 In the former, there is a profound selection bias, and in the latter, no sure conclusion can be drawn due to the fact that the effect of the second-line therapy cannot be isolated from that of the primary treatment. This leads to a great discrepancy between applied practices, which ultimately are governed by various factors such as the treating physician's preference, regional nonvalidated protocols, availability of specialized equipment (such as that for stereotactic radiotherapy, radiosurgery, or brachytherapy), and the structure and financial resources of the health system itself.…”

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confidence: 99%

Survival effects of a strategy favoring second-line multimodal treatment compared to supportive care in glioblastoma patients at first progression

Stavrinou

Kalyvas

Grau

et al. 2019

Journal of Neurosurgery

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OBJECTIVEData on the survival effects of supportive care compared to second-line multimodal treatment for glioblastoma progression are scarce. Thus, the authors assessed survival in two population-based, similar cohorts from two European university hospitals with different treatment strategies at first progression.METHODSThe authors retrospectively identified patients with newly diagnosed glioblastoma treated at two neurooncological centers. After diagnosis, patients from both centers received identical treatments, but at tumor progression each center used a different approach. In the majority of cases, at center A (Greece), supportive care or a single therapeutic modality was offered at progression, whereas center B (Germany) provided multimodal second-line therapy. The main outcome measure was survival after progression (SaP). The influence of the treatment strategy on SaP was assessed by multivariate analysis.RESULTSOne hundred three patients from center A and 156 from center B were included. Tumor progression was observed in 86 patients (center A) and 136 patients (center B). At center A, 53 patients (72.6%) received supportive care alone, while at center B, 91 patients (80.5%) received second-line treatment. Progression-free survival at both centers was similar (9.4 months [center A] vs 9.0 months [center B]; p = 0.97), but SaP was significantly improved in the patients treated with multimodal second-line therapy at center B (7 months, 95% CI 5.3–8.7 months) compared to those treated with supportive care or a single therapeutic modality at center A (4.5 months, 95% CI 3.5–5.5 months; p = 0.003). In the multivariate analysis, the treatment center was an independent prognostic factor for overall survival (HR 1.59, 95% CI 0.17–2.15; p = 0.002).CONCLUSIONSTreatment strategy favoring multimodal second-line treatment over minimal treatment or supportive care at glioblastoma progression is associated with significantly better overall survival.

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Usefulness of Reintervention in Recurrent Glioblastoma: An Indispensable Weapon for Increasing Survival

Cited by 30 publications

References 26 publications

A Meta-Analysis of Survival Outcomes Following Reoperation in Recurrent Glioblastoma: Time to Consider the Timing of Reoperation

A Meta-Analysis of Survival Outcomes Following Reoperation in Recurrent Glioblastoma: Time to Consider the Timing of Reoperation

Comparison of the Functional State and Motor Skills of Patients after Cerebral Hemisphere, Ventricular System, and Cerebellopontine Angle Tumor Surgery

Survival effects of a strategy favoring second-line multimodal treatment compared to supportive care in glioblastoma patients at first progression

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