Cytoreductive surgery of glioblastoma as the key to successful adjuvant therapies: new arguments in an old discussion
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This article discusses data from 3 randomized phase 3 trials, supporting a role for surgery in glioblastoma.
Data were reviewed by extent of resection during primary surgery from the ALA-Glioma Study (fluorescence-guided versus conventional resection), the BCNU wafer study (BCNU wafer versus placebo), and the EORTC Study 26981–22981 (radiotherapy versus chemoradiotherapy with temozolomide).
For glioblastoma patients in the ALA study, median survival was 16.7 and 11.8 months for complete versus partial resection, respectively (P < 0.0001). Survival effects were maintained after correction for differences in age and tumor location. For glioblastoma patients who received ≥90% resection in the BCNU wafer study, median survival increased for BCNU wafer versus placebo (14.5 versus 12.4 months, respectively; P = 0.02), but no survival increase was found for <90% resection (11.7 versus 10.6 months, respectively; P = 0.98). In the EORTC study, absolute median gain in survival with chemoradiotherapy versus radiotherapy was greatest for complete resections (+4.1 months; P = 0.0001), compared with partial resections (+1.8 months; P = 0.0001), or biopsies (+1.5 months; P = 0.088), suggesting surgery enhanced adjuvant treatment.
Complete resection appears to improve survival and may increase the efficacy of adjunct/adjuvant therapies. If safely achievable, complete resection should be the surgical goal for glioblastoma.
Keywords5-aminolevulinic acid BCNU wafer Glioblastoma Surgery Temozolomide
We would like to thank Dr. Roger Stupp for insightful comments on the manuscript. We also want to thank Susan Wingeron, Michael Raffin and Donna Stefanoni from Nexus Communications, Inc. (North Wales, PA) for their editorial assistance, which was financially supported by Archimedes Pharma.
Conflicts of interest
Walter Stummer, MD, PhD, has received research funding from Medac GmbH and is a consultant with Medac GmbH. Martin J. van den Bent, MD, PhD, is a consultant for MSD and is member of the MSD speakersbureau. Manfred Westphal, MD, PhD, has received honoraria from Ark Therapeutics and Archimedes Pharma.
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