High-grade glioma or glioblastoma multiforme (GBM) is the most common primary cerebral tumor, comprising 65% of all glial adult tumors. The median survival for patients with GBM is poor. Several studies have evaluated the benefits of salvage surgery on overall survival and quality of life in GBM patients who suffer recurrence but have been hampered by patient selection factors and diagnostic uncertainty regarding what constitutes disease relapse or progression. Current general guidelines suggest that younger patients with high performance status who develop recurrent or progressive disease after long intervals following primary surgery are offered a mild survival and quality of life improvement by repeat surgery. We retrospectively analyzed the survival of 63 GBM patients who underwent repeat cranial surgery in Northern Sydney/Central Coast Area Health Service between 1997 and 2007. Patients were separated into three groups according to the timing of their repeat surgery after their initial operation: patients in Group 1 had repeat surgery before they completed radiotherapy; Group 2 had repeat surgery between 2 months and 1 year following radiotherapy; and Group 3 had repeat surgery after 1 year. There was no statistical significance between the median ages of each group. The median survival for patients in Group 1 was 10.6 months; Group 2, 12.3 months; and Group 3, 28.1 months. There was no statistically significant difference between Group 1 and Group 2 with respect to survival. Group 3 had a statistically significant survival advantage compared to Groups 1 and 2. In the past, patients who deteriorated early may have been counseled against undergoing repeat surgery on the basis of aggressive tumor biology and dismal clinical outlook; however, we propose that patients whose disease relapses or progresses in the early postoperative period before the completion of radiotherapy should be offered repeat surgical intervention using the same selection processes as other GBM patients whose disease relapses later, as the survival for these patients is no worse.
|Number of pages||1|
|Publication status||Published - Oct 2008|
|Event||13th Annual Meeting of the Society-for-Neuro-Oncology (SNO) - Las Vegas, United States|
Duration: 20 Nov 2008 → 23 Nov 2008