Introduction: Glioblastoma is the most common malignancy of the central nervous system with a poor outcome because of its tendency for recurrences. There are divergent opinions regarding the management of glioblastoma recurrence. Therefore, the authors retrospectively analyze the results in a series of 202 patients with glioblastoma recurrences operated in our clinic and identify the clinical and neuroimaging criteria associated with a better postoperative outcome.
Methods: The authors of this study present a series of 260 surgical procedures performed for glioblastoma recurrences in 202 patients admitted in our clinic between 1998 and 2014. All patients followed radiotherapy and chemotherapy after the initial surgical procedure. The majority of patients, 163 cases (80,8%) underwent one operation for recurrences, 24 patients (11,9%)have been operated for two times, 11 patients (5,4%) for three times and 4 patients (1,9%)for four times.
Results: The surgical mortality in this series was 1,2 % and morbidity (new neurological deficits postoperatively) was 9,5%. The medium survival time for recurrent glioblastoma was 11,5 months. The average total survival time (since the initial diagnostic) of the patients included in our series was 21,8 months (interval between 6 months and 96 months). Several preoperative criteria were found to be predictive for a better outcome in patients operated recurrences of glioblastoma: age<70 years, KPS score>80, lobar and non-dominant hemispheres location.
Conclusions: Tumor resection should be considered for the following cases of glioblastoma recurrences: age<70 years, lobar location, tumor location in non-dominant hemispheres and symptoms related to tumor mass-effect. The cost-benefit analyze was in favor of surgery compared with second and third line chemotherapy. However the final decision depends on the patient's choice. Therefore, careful selection of the patients, based on analysis of specific preoperative criteria, is important in order to obtain a better outcome and a good quality of life postoperatively.
Patient Care: This research could improve the postoperative outcome of the patients operated for glioblastom reccurences
Learning Objectives: Finding new preoperative criteria which predict a better postoperative outcome for the patients with glioblastoma reccurence