title: The use of isoflurane and desflurane as inhalational agents for glioblastoma surgery. A survival analysis.
abstract: BACKGROUND
  Several studies have examined the impact of anesthetics on cancer recurrence. Isoflurane but not desflurane has protumoral effects. We hypothesize the use of isoflurane but not desflurane during surgery for primary GBM is an independent predictor of disease progression and mortality.
  
  
  METHODS
  378 adult patients were included in the study. The progression free survival (PFS) and overall survival (OS) rates at 1 and 5years were compared in patients who had either desflurane or isoflurane alone or in combination with propofol infusion. Multivariate analyses were conducted to test the association between preoperative, intraoperative and postoperative hyperglycemia with PFS and OS.
  
  
  RESULTS
  Kaplan-Meier curves demonstrated similar survival in patients who had either desflurane or isoflurane. The use of a propofol infusion during surgery did not affect survival. Univariate analysis demonstrated that age, body mass index and the adjusted Charlson comorbidity score were associated with reduced survival. The multivariate analysis confirmed that age and BMI but not the type volatile anesthetic use were independent prognostic factors for PFS (HR, 95%CI: 1.07, 0.85-1.37, 9=0.531) and OS (HR, 95%CI: 1.13, 0.86-1.48, p=0.531).
  
  
  CONCLUSIONS
  The use of isoflurane or desflurane during GBM surgery is not associated with reduced PFS or OS.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Department of Biostatistics, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA. Electronic address: jcata@mdanderson.org.
authors.forename: J P
authors.initials: JP
authors.lastname: Cata
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: K B
authors.initials: KB
authors.lastname: Hagan
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: S D O
authors.initials: SD
authors.lastname: Bhavsar
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: R
authors.initials: R
authors.lastname: Arunkumar
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: R
authors.initials: R
authors.lastname: Grasu
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: A
authors.initials: A
authors.lastname: Dang
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: R
authors.initials: R
authors.lastname: Carlson
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: B
authors.initials: B
authors.lastname: Arnold
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Potylchansky
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: I
authors.initials: I
authors.lastname: Lipski
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: T
authors.initials: T
authors.lastname: McHugh
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: F
authors.initials: F
authors.lastname: Jimenez
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: A T
authors.initials: AT
authors.lastname: Nguyen
authors.affiliation: Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
authors.forename: L
authors.initials: L
authors.lastname: Feng
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: T F
authors.initials: TF
authors.lastname: Rahlfs
mesh_terms: D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D000077335:Desflurane; D018572:Disease-Free Survival; D005260:Female; D005909:Glioblastoma / Q000601:surgery*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D007530:Isoflurane / Q000031:analogs & derivatives*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D018685:Anesthetics, Inhalation; D000077335:Desflurane; D007530:Isoflurane
keywords: Desflurane; Glioblastoma multiforme; Isoflurane; Overall survival; Progression free survival