title: Patterns of intracranial glioblastoma recurrence after aggressive surgical resection and adjuvant management: retrospective analysis of 43 cases.
abstract: The present retrospective study evaluated the recurrence patterns after aggressive surgical removal of intracranial glioblastomas in 43 consecutive adult patients. The resection rate of the enhanced lesion on magnetic resonance imaging was 100% and 95-99% in 22 and 21 cases, respectively. All patients received postoperative fractionated radiotherapy (60 Gy in 30 fractions) with additional chemotherapy (25 cases) or vaccine therapy (18 cases). During follow-up (median 17 months), tumor recurrence was identified in 33 patients, most frequently regional within the wall of the resection cavity (20 cases). No clinical factor differed significantly between the groups of patients with regional or marginal tumor progression (N = 22) and patients with distant or multiple recurrences (N = 8). Progression-free survival did not differ significantly between these two groups (p = 0.27). However, overall survival was significantly longer (p = 0.04) in patients with regional or marginal tumor progression, and constituted 90% and 54% at 1 and 2 years after surgery, respectively, compared to 75% and 0% in patients with distant or multiple recurrences. Aggressive surgical resection and adjuvant management of intracranial glioblastoma may change its recurrence pattern. Tumor progression appears in the wall of the resection cavity or within 2 cm from its margin in approximately half of patients.
authors.affiliation: Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Konishi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Muragaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iseki
authors.forename: Norio
authors.initials: N
authors.lastname: Mitsuhashi
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Okada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D019496:Cancer Vaccines / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000517:prevention & control / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D019496:Cancer Vaccines