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  • Multiple Surgical Resections for Patients with Glioblastoma: Prolonging Survival

    Final Number:

    Kaisorn Chaichana MD; Jon D. Weingart MD; Alessandro Olivi MD; Gary L. Gallia MD; Michael Lim MD; Henry Brem MD; Alfredo Quinones-Hinojosa MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Glioblastoma (GB) is the most common and aggressive type of primary brain tumor in adults. These tumors recur regardless of intervention. This propensity to recur despite aggressive therapies has made many perceive that repeated surgical resections have little utility.

    Methods: Adult patient who underwent surgery for an intracranial primary GB at an academic tertiary-care institution between 1997 and 2007 were retrospectively reviewed. Multivariate proportional hazards regression analysis was used to identify an association between GB resection number and survival after controlling for factors known to be associated with survival (age, functional status, periventricular location, extent of resection, adjuvant therapy). Survival as a function of time was plotted using Kaplan-Meier method, and survival rates were compared using Log-rank analysis. Variables with p<0.05 were considered statistically significant.

    Results: 578 patients with primary GB met the inclusion/exclusion criteria. At last follow-up, 354, 168, 41, and 15 patients underwent one, two, three, and four resections, respectively. The median survival for patients who underwent one, two, three, and four resections was 6.8, 15.5, 22.4, and 26.6 months (p<0.05). In multivariate analysis, patients who had only one resection had shortened survival [RR(9%%CI); 3.400 (2.423-4.774), p<0.0001] as compared to patients who underwent two [RR(95%CI); 0.688 (0.525-0.898), p=0.0006], three [RR(95%CI); 0.614 (0.388-0.929), p=0.02], and four [RR(95%CI); 0.600 (0.238-0.853), p=0.01] resections.

    Conclusions: Patients with GB will inevitably have recurrence. The present study shows that patients with recurrent GB can have improved survival with repeated resections. The findings of this study, however, may be limited by an intrinsic bias associated with patient selection. We aimed to minimize these biases by using strict inclusion criteria, multivariate analyses, and case-control evaluation.

    Patient Care: Patients with glioblastoma are often withheld aggressive therapies. Patients with glioblastoma and recurrence may benefit from repeated resections.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of repeated resection for patients with Glioblastoma, 2) Discuss, in small groups, the role of repeat resection for recurrent Glioblastoma, 3) Identify an effective treatment to prolong survival for patients with Glioblastoma.

    References: Barker FG, 2nd, Chang SM, Gutin PH, Malec MK, McDermott MW, Prados MD, et al: Survival and functional status after resection of recurrent glioblastoma multiforme. Neurosurgery 42:709-720; discussion 720-703, 1998 Chaichana K, Parker S, Olivi A, Quinones-Hinojosa A: A proposed classification system that projects outcomes based on preoperative variables for adult patients with glioblastoma multiforme. Journal of neurosurgery 112:997-1004, 2010 Harsh GRt, Levin VA, Gutin PH, Seager M, Silver P, Wilson CB: Reoperation for recurrent glioblastoma and anaplastic astrocytoma. Neurosurgery 21:615-621, 1987 Hau P, Baumgart U, Pfeifer K, Bock A, Jauch T, Dietrich J, et al: Salvage therapy in patients with glioblastoma: is there any benefit? Cancer 98:2678-2686, 2003 Keles GE, Anderson B, Berger MS: The effect of extent of resection on time to tumor progression and survival in patients with glioblastoma multiforme of the cerebral hemisphere. Surgical neurology 52:371-379, 1999

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