Residual tumor volume and patient survival following reoperation for recurrent glioblastoma

Abstract

Object Maximal safe tumor resection is part of the standard of care for patients with newly diagnosed glioblastoma. The role of reoperation in the care of patients with recurrent glioblastoma is less clear, and less than a quarter of patients undergo a second surgery. Previous studies have identified preoperative variables associated with the improved survival of patients following reoperation, and guidelines for the selection of patients for reoperation have been devised and validated. In this study, the authors analyzed the relative survival benefit of maximal safe tumor removal in a series of patients with recurrent glioblastoma who all underwent reoperation. Methods In this longitudinal study, the clinical and radiological data of 97 consecutive patients who underwent reoperation for recurrent glioblastoma were prospectively collected. Multiple regression analyses and Kaplan-Meier plotting were performed to identify pre- and postoperative clinical and radiological variables associated with increased survival following reoperation. Results The median postoperative survival of all patients following reoperation was 12.4 months (95% confidence interval [CI] 9.0–15.6 months). Multiple Cox regression analysis revealed that patients with large (> 3 cm3) residual tumors following reoperation had significantly decreased survival relative to those with residual tumors that were small (> 0–3 cm3; hazard ratio [HR] = 3.10, 95% CI 1.69–5.70; p < 0.001) or radiologically absent (0 cm3; HR = 5.82, 95% CI 2.98–11.37; p < 0.001). Large residual tumors had faster rates of subsequent regrowth than small (odds ratio [OR] = 4.22, 95% CI 1.19–14.97; p = 0.026) or radiologically absent (OR = 11.00, 95% CI 2.79–43.43; p = 0.001) residual tumors, and a faster regrowth rate was significantly associated with decreased survival (HR = 4.01, 95% CI 2.26–7.14; p < 0.001). Conclusions The overall survival of patients with recurrent glioblastoma who underwent reoperations increased with decreasing postoperative residual tumor volumes. For patients meeting prognostic criteria for reoperation, the surgical goal should be to minimize residual tumor volume to maximize overall survival. Clinical trial registration no.: NCT00060541 (ClinicalTrials.gov).

Therapeutic options in recurrent glioblastoma—An update

“…Similarly, a prospective non-randomized registry for patients with repeat surgery identified a correlation between (high) extent of resection and survival [31].…”

Performance of adjuvant treatment correlates with survival in reoperated glioblastomas

“…Yong et al 22 confirmed the relevance of the extent of resection at reoperation after finding that a residual tumor volume of less than 3 cm 3 after reoperation exerted an impact on the patients' survival: OS values were 20 months in patients with TR, 11 months in patients with residual tumor volume less than 3 cm 3 and five months when the residual . Following a study with 170 patients, Oppenlander et al 23 concluded that an extent of resection larger than 80% in repeated surgery suffices to increase patients' survival.…”

Retrospective and Randomized Analysis of Influence and Correlation of Molecular and Clinical Prognostic Factors in a Mono-Operative Series of 122 Patients with Glioblastoma Treated with STR or GTR

“…The number of months between tumour removal and disease recurrence was, however, the independent variable most specifically related to OS (B = .313, t(42)= 3,213, p=.003) and was also related to post-operative KPS. This parameter summarizes the validity of the treatment and can be influenced by the presence of tumor residue [31] and resistance to treatment with temozolomide [20].…”

“…Surgery was performed by the same first operator with the aid of the following: neuronavigation system, intraoperative ultrasound, ultrasound aspirator (CUSA-CAVITRON), thulium laser and intraoperative neurophysiological monitoring. 19.40% of the procedures was conducted in awake surgery so as to monitor, real-time, the functions of the patient during surgery in eloquent areas. GTR was performed in 85.95% of cases, while STR in the residual 14.05%.…”