The choice of anaesthesia for glioblastoma surgery does not impact the time to recurrence

Grau, Stefan; Löhr, Mario; Taurisano, Valeria; Trautner, Herbert; Timmer, Marco; Schwab, Stephanie; Hampl, Jürgen A.; Annecke, Thorsten

doi:10.1038/s41598-020-62087-8

Cited by 19 publications

(13 citation statements)

References 16 publications

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“…The studies included 158 and 294 patients and concluded that the TIVA was not associated with any improvement in survival. 35 , 36 These studies suggest that the method of delivering general anesthetics does not influence GBM progression after surgery.…”

Section: Impact Of Anesthetics and Analgesics On Gbm Progressionmentioning

confidence: 85%

Impact of anesthesia and analgesia techniques on glioblastoma progression. A narrative review

Privorotskiy

Bhavsar

Lang

et al. 2020

Neuro-Oncology Advances

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Glioblastoma (GBM) is an aggressive malignant central nervous system tumor with a median survival of 15 months after diagnosis. Standard therapy for GBM includes surgical resection, radiation, and temozolomide. Recently, anesthetics and analgesics have received attention for their potential involvement in mediating tumor growth. This narrative review investigated whether various members of the two aforementioned classes of drugs have a definitive impact on GBM progression by summarizing pertinent in vitro, in vivo, and clinical studies. Recent publications regarding general anesthetics have been inconsistent, showing that they can be pro-tumoral or antitumoral depending on the experimental context. The local anesthetic lidocaine has shown consistent antitumoral effects in vitro. Clinical studies looking at anesthetics have not concluded that their use improves patient outcomes. In vitro and in vivo studies looking at opioid involvement in GBM have demonstrated inconsistent findings regarding whether these drugs are pro-tumoral or antitumoral. NSAIDs, and specifically COX-2 inhibitors, have shown inconsistent findings across multiple studies looking at whether they are beneficial in halting GBM progression. Until multiple repeatable studies show that anesthetics and analgesics can suppress GBM growth, there is no strong evidence to recommend changes in the anesthetic care of these patients.

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Section: Impact Of Anesthetics and Analgesics On Gbm Progressionmentioning

confidence: 85%

Impact of anesthesia and analgesia techniques on glioblastoma progression. A narrative review

Privorotskiy

Bhavsar

Lang

et al. 2020

Neuro-Oncology Advances

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“…Propofol induced apoptosis in contrast with isoflurane which increased proliferation of glioblastoma stem cells, however the results have not been consistent because of the differences induced by the cell line [29,38]. The conclusion that Grau et al have reached shows no difference between volatile agents and TIVA regarding glioblastoma recurrence (volatiles 8 vs. propofol 8,4 months) or overall survival (volatiles 16,9 vs. propofol 17,4 months) [13].…”

Section: Intravenous Agents Such As Propofol Interact Withmentioning

confidence: 96%

Physiological alteration and anaesthetic drugs effects on intraoperative neurophysiological monitoring procedures

Coșman¹,

Atomei²,

Straticiuc³

et al. 2020

roneuro

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Intraoperative neurophysiological monitoring (IOM) and especially motor evoked potentials represents an important tool in the evaluation of the nervous system integrity and particularly of the motor tracts. A real and correct registration of the potentials with a proper interpretation of the modification is mandatory for an optimal outcome in eloquent areas, tumours, brainstem and medullary lesions. For all this to happen a suitable anaesthetic protocol must be used. Even though there is a large spectrum of anaesthetic agents at our disposal it is imperative to know their effect on the IOM signals recordings and the fact that some of them are dose-dependent. Drugs effects and physiological changes produced intraoperatively must be corrected before a shift in the direction of the surgical lesion resection it is taken. We present an overview of the action of the anaesthetic agents, most used protocols and the physiological alteration encountered in the operative theatre.

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“…More similar studies have been published, some with overall survival at different time points as the main outcome, some studying the duration of recurrence free survival [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ]. The number of included patients in studies with results that do not support the hypothesis [ 33 , 37 , 38 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] and studies supporting it [ 34 , 35 , 36 , 39 , 40 , 41 , 51 , 52 , 53 , 54 , 55 , 56 ], are quite equal. If anything, there are more patients in studies without support for the hypothesis.…”

Section: Retrospective Patient Studiesmentioning

confidence: 99%

Is It Definitely Clear That Long-Term Survival after Breast Cancer Surgery Is Not Affected by Anaesthetics?

Enlund

2021

Cancers

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Retrospective studies indicate that cancer survival may be affected by the anaesthetic technique. Propofol seems to be a better choice than volatile anaesthetics, such as sevoflurane. The first two retrospective studies suggested better long-term survival with propofol, but not for breast cancer. Subsequent retrospective studies from Asia indicated the same. When data from seven Swedish hospitals were analysed, including 6305 breast cancer patients, different analyses gave different results, from a non-significant difference in survival to a remarkably large difference in favour of propofol, an illustration of the innate weakness in the retrospective design. The largest randomised clinical trial, registered on clinicaltrial.gov, with survival as an outcome is the Cancer and Anesthesia study. Patients are here randomised to propofol or sevoflurane. The inclusion of patients with breast cancer was completed in autumn 2017. Delayed by the pandemic, one-year survival data for the cohort were presented in November 2020. Due to the extremely good short-term survival for breast cancer, one-year survival is of less interest for this disease. As the inclusions took almost five years, there was also a trend to observe. Unsurprisingly, no difference was found in one-year survival between the two groups, and the trend indicated no difference either.

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The choice of anaesthesia for glioblastoma surgery does not impact the time to recurrence

Cited by 19 publications

References 16 publications

Impact of anesthesia and analgesia techniques on glioblastoma progression. A narrative review

Impact of anesthesia and analgesia techniques on glioblastoma progression. A narrative review

Physiological alteration and anaesthetic drugs effects on intraoperative neurophysiological monitoring procedures

Is It Definitely Clear That Long-Term Survival after Breast Cancer Surgery Is Not Affected by Anaesthetics?

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