The impact of repeated surgery and adjuvant therapy on survival for patients with recurrent glioblastoma

Bonis, Pasquale De; Fiorentino, Alba; Anile, Carmelo; Boccadoro, Mario; Pompucci, Angelo; Chiesa, S.; Sica, Gigliola; Lama, Gina; Maira, Giulio; Mangiola, Annunziato

doi:10.1016/j.clineuro.2012.08.030

Cited by 57 publications

(53 citation statements)

References 28 publications

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“…Several older surgical outcome series have identified preoperative KPS as an important factor related to survival (24) or prolonged high QoL survival after recurrence (25). Also, KPS at recurrence in many studies turned out to be associated with better OS (19,(26)(27)(28)(29)(30). Patients with a poor performance scale are generally not proposed to undergo repeat surgery.…”

Section: Karnofsky Performance Scale and Age At Recurrencementioning

confidence: 99%

“…In a smaller series, however, De Bonis et al did not find a survival advantage for patients who received a GTR (11 patients) versus partial resection (22 patients) (27). Suchorska et al analyzed post hoc the influence of reoperation in patients of the DIRECTOR trial, originally designed to test different dosing schemes of temozolomide administered at recurrence.…”

Section: Extent Of Resection In the Recurrent Glioblastoma Extent Of mentioning

confidence: 99%

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Recurring Glioblastoma: A Case for Reoperation?

Dejaegher

Vleeschouwer

2017

Glioblastoma

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Unlike newly diagnosed glioblastoma, no clear or widely accepted standard of care is available for patients with a recurrence. A purely radiological diagnosis of recurrence or progression can be hampered by flaws induced by pseudoprogression, pseudoresponse, or radionecrosis. Based on parameters like tumor location and volume, patient' s performance status, time from initial diagnosis, and availability of alternative salvage therapies, reoperation can be considered as a treatment option to extend the overall survival and quality of life of the patient. The achieved extent of resection of the relapsed tumor-especially with the intention of having a safe, complete resection of the enhancing tumor-most likely plays a crucial role in the ultimate outcome and prognosis of the patient, regardless of other modes of treatment. Validated scores to predict the prognosis after reoperation of a patient with a recurrent glioblastoma can help to select suitable candidates for surgery. Safety issues and complication avoidance are pivotal to maximally preserve the patient' s quality of life. Besides a possible direct oncological effect, resampling of the recurrent tumor with detailed pathological and molecular analysis might have an impact on the development, testing, and validation of new salvage therapies.

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Section: Karnofsky Performance Scale and Age At Recurrencementioning

confidence: 99%

Section: Extent Of Resection In the Recurrent Glioblastoma Extent Of mentioning

confidence: 99%

Recurring Glioblastoma: A Case for Reoperation?

Dejaegher

Vleeschouwer

2017

Glioblastoma

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“…Treatment options for recurrent GBM remain controversial and depend on tumor size, location, and the patients' performance state [7]. Reoperation and retreatment with radiotherapy have been associated with increased complication and morbidity rates [8,9,10]. Treatment for recurrent GBM mainly comprises chemotherapy, which presents its own toxic side effects [7,11,12].…”

Section: Introductionmentioning

confidence: 99%

Gamma Knife Radiosurgery in Recurrent Glioblastoma

Frischer

Marosi

Wöehrer³

et al. 2016

Stereotact Funct Neurosurg

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Background: We evaluated Gamma Knife radiosurgery (GKRS) as a treatment option for patients with recurrent glioblastoma. Patients and Methods: 42 patients with histopathologically diagnosed recurrent grade IV tumor were treated with GKRS. All patients had undergone standard multimodal first-line treatment. The average time from diagnosis to GKRS was 17.0 months. The median target volume was 5.1 cm³. The median margin dose was 10 Gy and the median central dose 20 Gy. In a subset of patients, O⁶-methylguanine methyltransferase (MGMT) promoter methylation analysis by pyrosequencing was performed. Results: Most patients did not develop complications after GKRS. Time to radiological progression after initial GKRS was 4.4 months (95% CI: 3.1-5.7 months). Radiological progression mainly occurred beyond the GKRS-irradiated area. The median survival time after initial GKRS was 9.6 months (95% CI: 7.7-11.5 months). The median overall survival time from diagnosis was 25.6 months (95% CI: 21.8-29.3 months). Patients with MGMT promoter methylation survived significantly longer (33.4 months; 95% CI: 21.2-45.5 months) compared to patients without MGMT promoter methylation (16.0 months; 95% CI: 8.0-23.9 months). Conclusion: GKRS seems to be a relatively safe salvage treatment option for recurrent glioblastoma for highly selected patients but must be seen as part of a multimodal treatment algorithm.

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“…While current glioma treatments include surgical resection, localized radiotherapy, and chemotherapy, the efficacy of this regiment remains minimal (De Bonis et al, 2013). The data presented here raises several important points, which could have a large impact on future treatment designs.…”

Section: Discussionmentioning

confidence: 99%

“…Complete resection of the tumor is impossible due to the infiltrative nature of the tumor cells. However, even with this aggressive treatment program, over 80% of patients inevitably relapse within 9 months following treatment (De Bonis et al, 2013).…”

Section: Clinical Aspects Of Glioblastomamentioning

confidence: 99%

Individual roles of p53 and NF1 in OPC Competition and Gliomagenesis

Gonzalez¹

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Glioblastoma remains one of the most deadly cancers due to their rapid onset and the limited effectiveness of therapies. Here we use a mouse genetic system termed Mosaic Analysis with Double Markers (MADM) to study progression towards malignancy in oligodendrocyte progenitor cells (OPC), the cell of origin of glioma. We use gene deletions to uncover individual roles of two commonly mutated tumor suppressor genes, p53 and NF1. NF1 acts as a negative regulator of OPC self-renewal and promoter of OPC differentiation, and p53 increases the permanent arrest of OPC proliferation during times of stress. Subsequent analysis revealed that the downstream NF1 effector, mTOR, is critical for OPC transformation. Furthermore, mutant OPCs expand at the expense of surrounding non-mutant OPCs through a mechanism termed cell competition, to maintain proper density in the brain. This cell competition phenomenon is critical for OPC transformation as the complete inhibition of this property leads to inhibition of gliomagenesis irrespective of p53 and NF1 mutations. In summary, our findings reveal distinct roles for p53 and NF1 during gliomagenesis and a unique cell-cell interaction during the progression that is critical for malignancy.

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The impact of repeated surgery and adjuvant therapy on survival for patients with recurrent glioblastoma

Cited by 57 publications

References 28 publications

Recurring Glioblastoma: A Case for Reoperation?

Recurring Glioblastoma: A Case for Reoperation?

Gamma Knife Radiosurgery in Recurrent Glioblastoma

Individual roles of p53 and NF1 in OPC Competition and Gliomagenesis

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