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Survival benefit of lobectomy for glioblastoma: moving towards radical supramaximal resection

  • Clinical Study
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Abstract

Purpose

Extent of resection remains a paramount prognostic factor for long-term outcomes for glioblastoma. As such, supramaximal resection or anatomic lobectomy have been offered for non-eloquent glioblastoma in an attempt to improve overall survival. Here, we conduct a propensity-matched analysis of patients with non-eloquent glioblastoma who underwent either lobectomy or gross total resection of lesion to investigate the efficacy of supramaximal resection of glioblastoma.

Methods

Patients who underwent initial surgery for gross total resection or lobectomy for non-eloquent glioblastoma at our tertiary care referral center from 2010 to 2019 were included for this propensity-matched survival analysis. Propensity scores were generated with the following covariates: age, location, preoperative KPS, product of perpendicular maximal tumor diameters, and product of perpendicular FLAIR signal diameters. Inverse probability of treatment weighting (IPTW) with generated propensity scores was used to compare progression-free survival and overall survival.

Results

Sixty-nine patients were identified who underwent initial resection of glioblastoma for non-eloquent glioblastoma from 2010 to 2019 (GTR = 37, lobectomy = 32). Using IPTW, overall survival (30.7 vs. 14.1 months) and progression-free survival (17.2 vs. 8.1 months were significantly higher in the lobectomy cohort compared to the GTR group (p < 0.001). There was no significant difference in pre-op or post-op KPS or complication rates between the two groups.

Conclusion

Our propensity-matched study suggests that lobectomy for non-eloquent glioblastoma confers an added survival benefit compared to GTR alone. For patients with non-eloquent glioblastoma, a supramaximal resection by means of an anatomic lobectomy should be considered as a primary surgical treatment in select patients if feasible.

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Abbreviations

GTR:

Gross total resection

KPS:

Karnofsky performance status

KM:

Kaplan–Meier

OS:

Overall survival

PFS:

Progression-free survival

LC:

Local control

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Funding

National Institute of Neurological Disorders and Stroke (Grant No. R25NS108937-01). Supported by grants from the American Cancer Society (M.I.d.l.F.) and the Sylvester Comprehensive Cancer Center (M.I.d.l.F.).

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA

    Ashish H. Shah, Anil Mahavadi, Long Di, Alexander Sanjurjo, Daniel G. Eichberg, Veronica Borowy, Javier Figueroa, Evan Luther, Alexa Semonche, Michael E. Ivan & Ricardo J. Komotar

  2. Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA

    Macarena Ines de la Fuente

  3. Sylvester Comprehensive Cancer Center, Miami, FL, USA

    Macarena Ines de la Fuente, Michael E. Ivan & Ricardo J. Komotar

Authors
  1. Ashish H. Shah
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  2. Anil Mahavadi
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  3. Long Di
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  4. Alexander Sanjurjo
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  5. Daniel G. Eichberg
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Correspondence to Ashish H. Shah.

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Dr. Ivan reports being a consultant to and receiving research funding from Medtronic and the NX Development Corporation.

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Shah, A.H., Mahavadi, A., Di, L. et al. Survival benefit of lobectomy for glioblastoma: moving towards radical supramaximal resection. J Neurooncol 148, 501–508 (2020). https://doi.org/10.1007/s11060-020-03541-5

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  • DOI: https://doi.org/10.1007/s11060-020-03541-5

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