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Should we reoperate for recurrent high-grade astrocytoma?

  • Clinical Study – Patient Study
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Abstract

Despite optimal treatment of post-operative radiotherapy and chemotherapy for newly diagnosed high-grade astrocytoma, nearly all patients eventually recur. However, the efficacy of reoperation for recurrent astrocytoma is still debatable as to different surgical indications. To investigate the therapeutic effect of reoperation on patients with recurrent high-grade astrocytoma more objectively, a retrospective case-matched study was carried out. The clinical data of 63 cases of recurrent high-grade astrocytoma treated between January 2006 and December 2008 were studied. A total of 21 cases received reoperation immediately after tumor recurrence, while 42 cases without reoperation were matched by gender, age, Karnofsky Performance Scale (KPS) score, histopathology, recurrent interval after the first operation, extent of initial surgery, adjuvant treatment and characteristics of recurrent tumor. The study showed that the median survival time was 7 months in the reoperation group, while in non-reoperation group, it was 4 months. There was significant difference on univariate analysis (P < 0.001). Moreover, the median duration time of progression-free survival (PFS) after tumor recurrence was significantly (P < 0.001) longer in the reoperation group (5 months) than that in the non-reoperation group (2.5 months). The prognostic factors of recurrent high-grade astrocytoma included reoperation, KPS score and tumor location. It was indicated that reoperation could prolong the survival time and improve the quality of survival in patients of recurrent high-grade astrocytoma.

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References

  1. Combs SE, Gutwein S, Schulz-Ertner D, van KM, Thilmann C, Edler L et al (2005) Temozolomide combined with irradiation as postoperative treatment of primary glioblastoma multiforme. Phase I/II study. Strahlenther Onkol 181:372–377

  2. DeAngelis LM (2005) Chemotherapy for brain tumors—a new beginning. N Engl J Med 352:1036–1038

    Article  PubMed  CAS  Google Scholar 

  3. Jeremic B, Milicic B, Grujicic D, Dagovic A, Aleksandrovic J, Nikolic N (2004) Clinical prognostic factors in patients with malignant glioma treated with combined modality approach. Am J Clin Oncol 27:195–204

    Article  PubMed  Google Scholar 

  4. Stupp R, Mason WP, den Bent MJv, Weller M, Fisher B, Taphoorn MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996

    Article  PubMed  CAS  Google Scholar 

  5. Taphoorn MJ, Stupp R, Coens C, Osoba D, Kortmann R, den Bent MJv et al (2005) Health-related quality of life in patients with glioblastoma: a randomised controlled trial. Lancet Oncol 6:937–944

    Article  PubMed  Google Scholar 

  6. Lee SW, Fraass BA, Marsh LH, Herbort K, Gebarski SS, Martel MK et al (1999) Patterns of failure following high-dose 3-D conformal radiotherapy for high-grade astrocytomas: a quantitative dosimetric study. Int J Radiat Oncol Biol Phys 43:79–88

    Article  PubMed  CAS  Google Scholar 

  7. Sneed PK, Gutin PH, Larson DA, Malec MK, Phillips TL, Prados MD et al (1994) Patterns of recurrence of glioblastoma multiforme after external irradiation followed by implant boost. Int J Radiat Oncol Biol Phys 29:719–727

    Article  PubMed  CAS  Google Scholar 

  8. Wallner KE, Galicich JH, Krol G, Arbit E, Malkin MG (1989) Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 16:1405–1409

    Article  PubMed  CAS  Google Scholar 

  9. Stupp R, Mason WP, den Bent MJv, Weller M, Fisher B, Taphoorn MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996

    Article  PubMed  CAS  Google Scholar 

  10. Huncharek M, Muscat J (1998) Treatment of recurrent high grade astrocytoma; results of a systematic review of 1,415 patients. Anticancer Res 18:1303–1311

    PubMed  CAS  Google Scholar 

  11. Gonzalez J, Gilbert MR (2005) Treatment of astrocytomas. Curr Opin Neurol 18:632–638

    Article  PubMed  CAS  Google Scholar 

  12. Yung WK, Prados MD, Yaya-Tur R, Rosenfeld SS, Brada M, Friedman HS et al (1999) Multicenter phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse. Temodal Brain Tumor Group. J Clin Oncol 17:2762–2771

    PubMed  CAS  Google Scholar 

  13. Wong ET, Hess KR, Gleason MJ, Jaeckle KA, Kyritsis AP, Prados MD et al (1999) Outcomes and prognostic factors in recurrent glioma patients enrolled onto phase II clinical trials. J Clin Oncol 17:2572–2578

    PubMed  CAS  Google Scholar 

  14. Yung WK, Albright RE, Olson J, Fredericks R, Fink K, Prados MD et al (2000) A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer 83:588–593

    Article  PubMed  CAS  Google Scholar 

  15. Butowski NA, Sneed PK, Chang SM (2006) Diagnosis and treatment of recurrent high-grade astrocytoma. J Clin Oncol 24:1273–1280

    Article  PubMed  CAS  Google Scholar 

  16. Hsieh PC, Chandler JP, Bhangoo S, Panagiotopoulos K, Kalapurakal JA, Marymont MH et al (2005) Adjuvant gamma knife stereotactic radiosurgery at the time of tumor progression potentially improves survival for patients with glioblastoma multiforme. Neurosurgery 57:684–692

    Article  PubMed  Google Scholar 

  17. Wen PY, Brandes AA (2009) Treatment of recurrent high-grade gliomas. Curr Opin Neurol 22:657–664

    Article  PubMed  CAS  Google Scholar 

  18. Harsh GR IV, Levin VA, Gutin PH, Seager M, Silver P, Wilson CB (1987) Reoperation for recurrent glioblastoma and anaplastic astrocytoma. Neurosurgery 21:615–621

    Article  PubMed  Google Scholar 

  19. Azizi A, Black P, Miyamoto C, Croul SE (2001) Treatment of malignant astrocytomas with repetitive resections: a longitudinal study. Isr Med Assoc J 3:254–257

    PubMed  CAS  Google Scholar 

  20. Vick NA, Ciric IS, Eller TW, Cozzens JW, Walsh A (1989) Reoperation for malignant astrocytoma. Neurology 39:430–432

    PubMed  CAS  Google Scholar 

  21. Durmaz R, Erken S, Arslantas A, Atasoy MA, Bal C, Tel E (1997) Management of glioblastoma multiforme: with special reference to recurrence. Clin Neurol Neurosurg 99:117–123

    Article  PubMed  CAS  Google Scholar 

  22. Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280

    PubMed  CAS  Google Scholar 

  23. Salford LG, Brun A, Nirfalk S (1988) Ten-year survival among patients with supratentorial astrocytomas grade III and IV. J Neurosurg 69:506–509

    Article  PubMed  CAS  Google Scholar 

  24. Wen PY, Kesari S (2008) Malignant gliomas in adults. N Engl J Med 359:492–507

    Article  PubMed  CAS  Google Scholar 

  25. Kristiansen K, Hagen S, Kollevold T, Torvik A, Holme I, Nesbakken R et al (1981) Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: a prospective multicenter trial of the Scandinavian Glioblastoma Study Group. Cancer 47:649–652

    Article  PubMed  CAS  Google Scholar 

  26. Walker MD, Alexander E, Hunt WE, MacCarty CS, Mahaley MS, Mealey J et al (1978) Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. J Neurosurg 49:333–343

    Article  PubMed  CAS  Google Scholar 

  27. Bauman GS, Sneed PK, Wara WM, Stalpers LJ, Chang SM, McDermott MW et al (1996) Reirradiation of primary CNS tumors. Int J Radiat Oncol Biol Phys 36:433–441

    Article  PubMed  CAS  Google Scholar 

  28. Combs SE, 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 

  29. Combs SE, Thilmann C, Edler L, Debus J, Schulz-Ertner D (2005) Efficacy of fractionated stereotactic reirradiation in recurrent gliomas: long-term results in 172 patients treated in a single institution. J Clin Oncol 23:8863–8869

    Article  PubMed  Google Scholar 

  30. Yung WK, Albright RE, Olson J, Fredericks R, Fink K, Prados MD et al (2000) A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer 83:588–593

    Article  PubMed  CAS  Google Scholar 

  31. Brem H, Piantadosi S, Burger PC, Walker M, Selker R, Vick NA et al (1995) Placebo-controlled trial of safety and efficacy of intraoperative controlled delivery by biodegradable polymers of chemotherapy for recurrent gliomas. The Polymer-brain Tumor Treatment Group. Lancet 345:1008–1012

    Article  PubMed  CAS  Google Scholar 

  32. DeVita VT Jr The James Ewing Lecture (1983) The relationship between tumor mass and resistance to chemotherapy. Implications for surgical adjuvant treatment of cancer. Cancer 51:1209–1220

    Google Scholar 

  33. Young B, Oldfield EH, Markesbery WR, Haack D, Tibbs PA, McCombs P et al (1981) Reoperation for glioblastoma. J Neurosurg 55:917–921

    Article  PubMed  CAS  Google Scholar 

  34. Barker FG II, Chang SM, Gutin PH, Malec MK, McDermott MW, Prados MD et al (1998) Survival and functional status after resection of recurrent glioblastoma multiforme. Neurosurgery 42:709–720 (discussion 720–723)

    Article  PubMed  Google Scholar 

  35. Boiardi A, Silvani A, Eoli M, Lamperti E, Salmaggi A, Gaviani P et al (2008) Treatment of recurrent glioblastoma: can local delivery of mitoxantrone improve survival. J Neurooncol 88:105–113

    Article  PubMed  CAS  Google Scholar 

  36. Guyotat J, Signorelli F, Frappaz D, Madarassy G, Ricci AC, Bret P (2000) Is reoperation for recurrence of glioblastoma justified. Oncol Rep 7:899–904

    PubMed  CAS  Google Scholar 

  37. Pinsker M, Lumenta C (2001) Experiences with reoperation on recurrent glioblastoma multiforme. Zentralbl Neurochir 62:43–47

    Article  PubMed  CAS  Google Scholar 

  38. Keles GE, Lamborn KR, Chang SM, Prados MD, Berger MS (2004) Volume of residual disease as a predictor of outcome in adult patients with recurrent supratentorial glioblastomas multiforme who are undergoing chemotherapy. J Neurosurg 100:41–46

    Article  PubMed  Google Scholar 

  39. Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F et al (2001) A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95:190–198

    Article  PubMed  CAS  Google Scholar 

  40. Park JK, Hodges T, Arko L, Shen M, Dello Iacono D, McNabb A et al (2010) Scale to predict survival after surgery for recurrent glioblastoma multiforme. J Clin Oncol 28:3838–3843

    Article  PubMed  Google Scholar 

  41. Jeremic B, Milicic B, Grujicic D, Dagovic A, Aleksandrovic J (2003) Multivariate analysis of clinical prognostic factors in patients with glioblastoma multiforme treated with a combined modality approach. J Cancer Res Clin Oncol 129:477–484

    Article  PubMed  Google Scholar 

  42. Irwin C, Hunn M, Purdie G, Hamilton D (2007) Delay in radiotherapy shortens survival in patients with high grade glioma. J Neurooncol 85:339–343

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was founded by National Natural Science Foundation of China (Grant Number: 30772243) and Zhejiang Province Foundation of Department of Education (Grant Number: Y200906536).

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None declared.

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Authors and Affiliations

  1. Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, 310009, People’s Republic of China

    Jin-fang Xu, Jun Fang, Jian-min Zhang, Wei-guo Liu & Hong Shen

  2. School of Public Health, Zhejiang University, Hangzhou City, 310009, People’s Republic of China

    Yi Shen

  3. Brain Medicine Institute, Zhejiang University, Hangzhou City, 310009, People’s Republic of China

    Jin-fang Xu, Jian-min Zhang, Wei-guo Liu & Hong Shen

Authors
  1. Jin-fang Xu
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  2. Jun Fang
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Correspondence to Wei-guo Liu or Hong Shen.

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Xu, Jf., Fang, J., Shen, Y. et al. Should we reoperate for recurrent high-grade astrocytoma?. J Neurooncol 105, 291–299 (2011). https://doi.org/10.1007/s11060-011-0585-6

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  • DOI: https://doi.org/10.1007/s11060-011-0585-6

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