title: Clinical benefit from resection of recurrent glioblastomas: results of a multicenter study including 503 patients with recurrent glioblastomas undergoing surgical resection.
abstract: BACKGROUND
  While standards for the treatment of newly diagnosed glioblastomas exist, therapeutic regimens for tumor recurrence remain mostly individualized. The role of a surgical resection of recurrent glioblastomas remains largely unclear at present. This study aimed to assess the effect of repeated resection of recurrent glioblastomas on patient survival.
  
  
  METHODS
  In a multicenter retrospective-design study, patients with primary glioblastomas undergoing repeat resections for recurrent tumors were evaluated for factors affecting survival. Age, Karnofsky performance status (KPS), extent of resection (EOR), tumor location, and complications were assessed.
  
  
  RESULTS
  Five hundred and three patients (initially diagnosed between 2006 and 2010) undergoing resections for recurrent glioblastoma at 20 institutions were included in the study. The patients' median overall survival after initial diagnosis was 25.0 months and 11.9 months after first re-resection. The following parameters were found to influence survival significantly after first re-resection: preoperative and postoperative KPS, EOR of first re-resection, and chemotherapy after first re-resection. The rate of permanent new deficits after first re-resection was 8%.
  
  
  CONCLUSIONS
  The present study supports the view that surgical resections of recurrent glioblastomas may help to prolong patient survival at an acceptable complication rate.
authors.affiliation: Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany (F.R., H.P., B.M.); Department of Neurosurgery, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany (M.S.); Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany (D.K.); Department of Neurosurgery, Universitätsmedizin Göttingen, , Göttingen, Germany (H.C.B.); Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany (M.M.); Department of Neurosurgery, Universitätsklinikum Freiburg, Freiburg, Germany (A.W.); Department of Neurosurgery, Universitätsklinikum Würzburg, Würzburg, Germany (T.W.); Department of Neurosurgery, Goethe Universität Frankfurt, Frankfurt, Germany (C.S.); Department of Neurosurgery, Inselspital, Universitätsklinikum Bern, Bern, Switzerland (P.S.); Department of Neurosurgery, Universitätskliniken Bonn, Rheinische Friedrich Wilhelms Universität, Bonn, Germany (M.S.).
authors.forename: Florian
authors.initials: F
authors.lastname: Ringel
authors.affiliation: Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany (F.R., H.P., B.M.); Department of Neurosurgery, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany (M.S.); Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany (D.K.); Department of Neurosurgery, Universitätsmedizin Göttingen, , Göttingen, Germany (H.C.B.); Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany (M.M.); Department of Neurosurgery, Universitätsklinikum Freiburg, Freiburg, Germany (A.W.); Department of Neurosurgery, Universitätsklinikum Würzburg, Würzburg, Germany (T.W.); Department of Neurosurgery, Goethe Universität Frankfurt, Frankfurt, Germany (C.S.); Department of Neurosurgery, Inselspital, Universitätsklinikum Bern, Bern, Switzerland (P.S.); Department of Neurosurgery, Universitätskliniken Bonn, Rheinische Friedrich Wilhelms Universität, Bonn, Germany (M.S.).
authors.forename: Haiko
authors.initials: H
authors.lastname: Pape
authors.affiliation: Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany (F.R., H.P., B.M.); Department of Neurosurgery, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany (M.S.); Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany (D.K.); Department of Neurosurgery, Universitätsmedizin Göttingen, , Göttingen, Germany (H.C.B.); Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany (M.M.); Department of Neurosurgery, Universitätsklinikum Freiburg, Freiburg, Germany (A.W.); Department of Neurosurgery, Universitätsklinikum Würzburg, Würzburg, Germany (T.W.); Department of Neurosurgery, Goethe Universität Frankfurt, Frankfurt, Germany (C.S.); Department of Neurosurgery, Inselspital, Universitätsklinikum Bern, Bern, Switzerland (P.S.); Department of Neurosurgery, Universitätskliniken Bonn, Rheinische Friedrich Wilhelms Universität, Bonn, Germany (M.S.).
authors.forename: Michael
authors.initials: M
authors.lastname: Sabel
authors.affiliation: Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany (F.R., H.P., B.M.); Department of Neurosurgery, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany (M.S.); Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany (D.K.); Department of Neurosurgery, Universitätsmedizin Göttingen, , Göttingen, Germany (H.C.B.); Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany (M.M.); Department of Neurosurgery, Universitätsklinikum Freiburg, Freiburg, Germany (A.W.); Department of Neurosurgery, Universitätsklinikum Würzburg, Würzburg, Germany (T.W.); Department of Neurosurgery, Goethe Universität Frankfurt, Frankfurt, Germany (C.S.); Department of Neurosurgery, Inselspital, Universitätsklinikum Bern, Bern, Switzerland (P.S.); Department of Neurosurgery, Universitätskliniken Bonn, Rheinische Friedrich Wilhelms Universität, Bonn, Germany (M.S.).
authors.forename: Dietmar
authors.initials: D
authors.lastname: Krex
authors.affiliation: Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany (F.R., H.P., B.M.); Department of Neurosurgery, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany (M.S.); Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany (D.K.); Department of Neurosurgery, Universitätsmedizin Göttingen, , Göttingen, Germany (H.C.B.); Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany (M.M.); Department of Neurosurgery, Universitätsklinikum Freiburg, Freiburg, Germany (A.W.); Department of Neurosurgery, Universitätsklinikum Würzburg, Würzburg, Germany (T.W.); Department of Neurosurgery, Goethe Universität Frankfurt, Frankfurt, Germany (C.S.); Department of Neurosurgery, Inselspital, Universitätsklinikum Bern, Bern, Switzerland (P.S.); Department of Neurosurgery, Universitätskliniken Bonn, Rheinische Friedrich Wilhelms Universität, Bonn, Germany (M.S.).
authors.forename: Hans Christoph
authors.initials: HC
authors.lastname: Bock
authors.affiliation: Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany (F.R., H.P., B.M.); Department of Neurosurgery, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany (M.S.); Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany (D.K.); Department of Neurosurgery, Universitätsmedizin Göttingen, , Göttingen, Germany (H.C.B.); Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany (M.M.); Department of Neurosurgery, Universitätsklinikum Freiburg, Freiburg, Germany (A.W.); Department of Neurosurgery, Universitätsklinikum Würzburg, Würzburg, Germany (T.W.); Department of Neurosurgery, Goethe Universität Frankfurt, Frankfurt, Germany (C.S.); Department of Neurosurgery, Inselspital, Universitätsklinikum Bern, Bern, Switzerland (P.S.); Department of Neurosurgery, Universitätskliniken Bonn, Rheinische Friedrich Wilhelms Universität, Bonn, Germany (M.S.).
authors.forename: Martin
authors.initials: M
authors.lastname: Misch
authors.affiliation: Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany (F.R., H.P., B.M.); Department of Neurosurgery, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany (M.S.); Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany (D.K.); Department of Neurosurgery, Universitätsmedizin Göttingen, , Göttingen, Germany (H.C.B.); Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany (M.M.); Department of Neurosurgery, Universitätsklinikum Freiburg, Freiburg, Germany (A.W.); Department of Neurosurgery, Universitätsklinikum Würzburg, Würzburg, Germany (T.W.); Department of Neurosurgery, Goethe Universität Frankfurt, Frankfurt, Germany (C.S.); Department of Neurosurgery, Inselspital, Universitätsklinikum Bern, Bern, Switzerland (P.S.); Department of Neurosurgery, Universitätskliniken Bonn, Rheinische Friedrich Wilhelms Universität, Bonn, Germany (M.S.).
authors.forename: Astrid
authors.initials: A
authors.lastname: Weyerbrock
authors.affiliation: Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany (F.R., H.P., B.M.); Department of Neurosurgery, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany (M.S.); Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany (D.K.); Department of Neurosurgery, Universitätsmedizin Göttingen, , Göttingen, Germany (H.C.B.); Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany (M.M.); Department of Neurosurgery, Universitätsklinikum Freiburg, Freiburg, Germany (A.W.); Department of Neurosurgery, Universitätsklinikum Würzburg, Würzburg, Germany (T.W.); Department of Neurosurgery, Goethe Universität Frankfurt, Frankfurt, Germany (C.S.); Department of Neurosurgery, Inselspital, Universitätsklinikum Bern, Bern, Switzerland (P.S.); Department of Neurosurgery, Universitätskliniken Bonn, Rheinische Friedrich Wilhelms Universität, Bonn, Germany (M.S.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Westermaier
authors.affiliation: Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany (F.R., H.P., B.M.); Department of Neurosurgery, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany (M.S.); Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany (D.K.); Department of Neurosurgery, Universitätsmedizin Göttingen, , Göttingen, Germany (H.C.B.); Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany (M.M.); Department of Neurosurgery, Universitätsklinikum Freiburg, Freiburg, Germany (A.W.); Department of Neurosurgery, Universitätsklinikum Würzburg, Würzburg, Germany (T.W.); Department of Neurosurgery, Goethe Universität Frankfurt, Frankfurt, Germany (C.S.); Department of Neurosurgery, Inselspital, Universitätsklinikum Bern, Bern, Switzerland (P.S.); Department of Neurosurgery, Universitätskliniken Bonn, Rheinische Friedrich Wilhelms Universität, Bonn, Germany (M.S.).
authors.forename: Christian
authors.initials: C
authors.lastname: Senft
authors.affiliation: Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany (F.R., H.P., B.M.); Department of Neurosurgery, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany (M.S.); Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany (D.K.); Department of Neurosurgery, Universitätsmedizin Göttingen, , Göttingen, Germany (H.C.B.); Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany (M.M.); Department of Neurosurgery, Universitätsklinikum Freiburg, Freiburg, Germany (A.W.); Department of Neurosurgery, Universitätsklinikum Würzburg, Würzburg, Germany (T.W.); Department of Neurosurgery, Goethe Universität Frankfurt, Frankfurt, Germany (C.S.); Department of Neurosurgery, Inselspital, Universitätsklinikum Bern, Bern, Switzerland (P.S.); Department of Neurosurgery, Universitätskliniken Bonn, Rheinische Friedrich Wilhelms Universität, Bonn, Germany (M.S.).
authors.forename: Philippe
authors.initials: P
authors.lastname: Schucht
authors.affiliation: Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany (F.R., H.P., B.M.); Department of Neurosurgery, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany (M.S.); Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany (D.K.); Department of Neurosurgery, Universitätsmedizin Göttingen, , Göttingen, Germany (H.C.B.); Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany (M.M.); Department of Neurosurgery, Universitätsklinikum Freiburg, Freiburg, Germany (A.W.); Department of Neurosurgery, Universitätsklinikum Würzburg, Würzburg, Germany (T.W.); Department of Neurosurgery, Goethe Universität Frankfurt, Frankfurt, Germany (C.S.); Department of Neurosurgery, Inselspital, Universitätsklinikum Bern, Bern, Switzerland (P.S.); Department of Neurosurgery, Universitätskliniken Bonn, Rheinische Friedrich Wilhelms Universität, Bonn, Germany (M.S.).
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meyer
authors.affiliation: Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany (F.R., H.P., B.M.); Department of Neurosurgery, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany (M.S.); Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany (D.K.); Department of Neurosurgery, Universitätsmedizin Göttingen, , Göttingen, Germany (H.C.B.); Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany (M.M.); Department of Neurosurgery, Universitätsklinikum Freiburg, Freiburg, Germany (A.W.); Department of Neurosurgery, Universitätsklinikum Würzburg, Würzburg, Germany (T.W.); Department of Neurosurgery, Goethe Universität Frankfurt, Frankfurt, Germany (C.S.); Department of Neurosurgery, Inselspital, Universitätsklinikum Bern, Bern, Switzerland (P.S.); Department of Neurosurgery, Universitätskliniken Bonn, Rheinische Friedrich Wilhelms Universität, Bonn, Germany (M.S.).
authors.forename: Matthias
authors.initials: M
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000601:surgery*; D005260:Female; D005909:Glioblastoma / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: glioblastoma; overall survival; recurrent tumor; surgical resection