Reoperation for Recurrent High-Grade Glioma: A Current Perspective of the Literature
Reoperation for recurrent WHO grade III and IV high-grade glioma can be an important part of the treatment strategy. The authors provide a comprehensive review of the published literature regarding this topic, including papers from January 1980 to August 2013. Of 31 studies identified for review, a majority (29) described survival benefit and/or improved functional status with surgery. Increased extent of resection correlated with improved survival, even if patients had not received gross total resection with their initial operation. Interestingly, age was not a contraindication to surgery. The authors conclude that the existing evidence strongly supports surgical resection of recurrent tumors in patients who are candidates for surgery. The primary limitation of this review is selection bias inherent in evaluating patients who are surgical candidates, since patients offered surgery are typically younger, healthier and less neurologically debilitated. However, patients with tumor recurrence as evidenced by imaging or clinical symptoms, and who are at least 6 months from their initial resection, likely benefit from reoperation in terms of overall survival.