Skip to main content

Advertisement

SpringerLink
Log in

Role of surgical resection in recurrent glioblastoma: prognostic factors and outcome evaluation in an observational study

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

The role of surgical resection in progressive or recurrent glioblastoma multiforme (GBM) lack of high level of evidence. The aim of this evaluation was to assess the role of surgical resection in relapsing GBM, in relation to the extent of surgical resection (EOR) and the amount of residual tumor volume (RTV). Among patients treated for newly diagnosed GBM between September 2008–December 2014, 64 patients with recurrent GBM were included in this retrospective evaluation. All patients underwent surgical resection followed by adjuvant treatments, chemotherapy and/or radiotherapy Results were evaluated in terms of local control (LC) rate, progression free survival (PFS) and patients overall survival (OS). Gross total resection (GTR) (>90%) was achieved in 48 (75%) patients and subtotal resection (STR) in 16 (25%). RTV was 0 in 40 (62.5%) patients and >0 in 24 (37.5%). No severe postoperative morbidity occurred. The median LC time was 6.0 ± 0.1 months (95% CI 5.29–8.55), with a 1 and 2 years LC rate of 29.4 ± 6.9%. The median PFS time was 6.8 ± 0.8 months, with a 1 year PFS rate of 27.2 ± 7.2% (95% CI 14.2–41.9). The median OS time was 10.3 ± 0.5 months (95% CI 7.6–10.4) with a 1 and 2 years OS rate of 22.5 ± 6.7% (95% CI 10.9–36.6). On univariate analysis EOR and RTV were recorded as conditioning LC and survival. These data was confirmed also in multivariate analysis only for RTV (p < 0.01). Recurrent GBM can take advantage of repeated surgery in selected patients with younger age and good clinical status. The entity of surgical resection was confirmed as conditioning survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Stupp R, Hegi M, Mason W et al (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EOTC-NCIC trial. Lancet Oncol 10:459–466

    Article  CAS  PubMed  Google Scholar 

  2. Johnson D, O’Neill B (2012) Glioblastoma survival in the United States before and during the temozolomide era. J Neurooncol 107:359–364

    Article  CAS  PubMed  Google Scholar 

  3. National Comprehensive Cancer Network NCCN guidelines (2012) Central nervous system cancers. http://www.nccn.org/professionals/physiciangls/fguidelines.asp

  4. Minniti G, Amelio D, Amichetti M et al (2010) Patterns of failure and comparison of different target volume delineations in patients with glioblastoma treated with conformal radiotherapy plus concomitant and adjuvant temozolomide. Radiother Oncol 97:377–381

    Article  CAS  PubMed  Google Scholar 

  5. Barbagallo G, Jenkinson M, Brodbelt A (2008) “Recurrent” glioblastoma multiforme, when should we reoperate? Br J Neurosurg 22:452–455

    Article  PubMed  Google Scholar 

  6. Park J, Hodges T, Arko L et al (2010) Scale to predict survival after surgery for recurrent glioblastoma multiforme. J Clin Oncol 28:3838–3843

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wick W, Platten M, Weller M (2009) New (alternative) temozolomide regimens for the treatment of gliomas. Neuro Oncol 11:69–79

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Wick W, Weller M, Weiler M, Matchelor T, Yung A, Platten M (2011) Pathway inhibition: emerging molecular targets for treating glioblastoma. Neuro Oncol 13:566–579

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Combs S, Widmer V, Thilmann C, Hof H, Debus J, Schulz-Ertner D (2005) Stereotactic radiosurgery (SRS): treatment option for recurrent glioblastoma multiforme (GBM). Cancer 104:2168–2173

    Article  PubMed  Google Scholar 

  10. Fuller C, Choi M, Forthuber B et al (2007) Standard fractionation intensity modulated radiation therapy (IMRT) of primary, recurrent glioblastoma multiforme. Radiat Oncol 2:26

    Article  PubMed  PubMed Central  Google Scholar 

  11. Navarria P, Ascolese A, Tomatis S et al. (2016) Hypofractionated stereotactic radiation therapy in recurrent high-grade glioma: a new challenge. Cancer Res Treat 48:37–44

    Article  PubMed  Google Scholar 

  12. Ammirati M, Galicich J, Arbit E, Liao Y (1987) Reoperation in the treatment of recurrent intracranial malignant gliomas. Neurosurgery 21:607–614

    Article  CAS  PubMed  Google Scholar 

  13. Barker F, Chang S, Gutin P et al (1998) Survival and functional status after resection of recurrent glioblastoma multiforme. Neurosurgery 42:709–720

    Article  PubMed  Google Scholar 

  14. Chaichana K, Zadnik P, Weingart J et al (2013) Multiple resections for patients with glioblastoma: prolonging survival. J Neurosurg 118:812–820

    Article  PubMed  Google Scholar 

  15. Dirks P, Bernstein M, Muller P, Tucker W (1993) The value of reoperation for recurrent glioblastoma. Can J Surg 36:271–275

    CAS  PubMed  Google Scholar 

  16. Helseth R, Helseth E, Johannesen T et al (2010) Overall survival, prognostic factors, and repeated surgery in a consecutive series of 516 patients with glioblastoma multiforme. Acta Neurol Scand 122:159–167

    Article  CAS  PubMed  Google Scholar 

  17. Berger M, Tucker A, Spence A, Winn H (1992) Reoperation for glioma. Clin Neurosurg 39:172–186

    CAS  PubMed  Google Scholar 

  18. Daneyemez M, Gezen F, Canakci Z, Kahraman S (1998) Radical surgery and reoperation in supratentorial malignant glial tumors. Minim Invasive Neurosurg 41:209–213

    Article  CAS  PubMed  Google Scholar 

  19. Park C, Kim J, Nam D et al (2013) A practical scoring system to determine whether to proceed with surgical resection in recurrent glioblastoma. Neuro Oncol 15:1096–1101

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bloch O, Han S, Cha S et al (2012) Impact of extent of resection for recurrent glioblastoma on overall survival. J Neurosurg 117:1032–1038

    Article  PubMed  Google Scholar 

  21. Oppenlander M, Wolf A, Snyder L et al (2014) An extent of resection threshold for recurrent glioblastoma and its risk for neurological morbidity. J Neurosurg 120:846–853

    Article  PubMed  Google Scholar 

  22. Patel A, Suki D, Hatiboglu M, Rao V, Fox B, Sawaya R (2015) Impact of surgical methodology on the complication rate and functional outcome of patients with a single brain metastasis. J Neurosurg 122:1132–1143

    Article  PubMed  Google Scholar 

  23. Mandl E, Dirven C, Buis D, Postma T, Vandertop W (2008) Repeated surgery for glioblastoma multiforme: only in combination with other salvage therapy. Surg Neurol 69:506–509

    Article  PubMed  Google Scholar 

  24. Sanai N, Polley M, McDermott M, Parsa A, Berger M (2011) An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg 115:3–8

    Article  PubMed  Google Scholar 

  25. McGirt M, Chaichana K, Gathinji M et al (2009) Independent association of extent of resection with survival in patients with malignant brain astrocytoma. Clinical article. J Neurosurg 110:156–162

    Article  PubMed  Google Scholar 

  26. Pessina F, Navarria P, Cozzi L et al (2016) Value of surgical resection in patients with newly diagnosed grade III glioma treated in a multimodal approach: surgery, chemotherapy and radiotherapy. Ann Surg Oncol 23:3040–3046

    Article  PubMed  Google Scholar 

  27. Lim DA, Cha S, Mayo MC et al (2007) Relationship of glioblastoma multiforme to neural stem cell regions predicts invasive and multifocal tumor phenotype. Neuro Oncol 9:424–429

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lamborn KR, Chang SM, Prados MD. (2004) Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro Oncol 6:227–235

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurooncological Surgery, Humanitas Cancer Center and Research Hospital, Milan, Italy

    Federico Pessina, Marco Riva & Lorenzo Bello

  2. Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Milan, Italy

    Pierina Navarria, Luca Cozzi, Stefano Tomatis, Anna Maria Ascolese & Marta Scorsetti

  3. Hematology and Oncology, Humanitas Cancer Center and Research Hospital, Milan, Italy

    Armando Santoro & Matteo Simonelli

  4. Department of Biomedical Sciences, Humanitas University, Milan, Italy

    Luca Cozzi, Armando Santoro & Marta Scorsetti

Authors
  1. Federico Pessina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pierina Navarria
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luca Cozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefano Tomatis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marco Riva
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anna Maria Ascolese
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Armando Santoro
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Matteo Simonelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lorenzo Bello
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Marta Scorsetti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luca Cozzi.

Ethics declarations

Conflict of interest

L. Cozzi acts as Scientific Advisor to Varian Medical Systems and is Clinical Research Scientist at Humanitas Cancer Center. All other co-authors have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pessina, F., Navarria, P., Cozzi, L. et al. Role of surgical resection in recurrent glioblastoma: prognostic factors and outcome evaluation in an observational study. J Neurooncol 131, 377–384 (2017). https://doi.org/10.1007/s11060-016-2310-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-016-2310-y

Keywords

Search

Navigation