Role of surgical resection in recurrent glioblastoma: prognostic factors and outcome evaluation in an observational study.
The role of surgical resection in progressive or recurrent glioblastoma multiforme (GBM) lack of high level of evidence. The aim of this evaluation was to assess the role of surgical resection in relapsing GBM, in relation to the extent of surgical resection (EOR) and the amount of residual tumor volume (RTV). Among patients treated for newly diagnosed GBM between September 2008-December 2014, 64 patients with recurrent GBM were included in this retrospective evaluation. All patients underwent surgical resection followed by adjuvant treatments, chemotherapy and/or radiotherapy Results were evaluated in terms of local control (LC) rate, progression free survival (PFS) and patients overall survival (OS). Gross total resection (GTR) (>90%) was achieved in 48 (75%) patients and subtotal resection (STR) in 16 (25%). RTV was 0 in 40 (62.5%) patients and >0 in 24 (37.5%). No severe postoperative morbidity occurred. The median LC time was 6.0 ± 0.1 months (95% CI 5.29-8.55), with a 1 and 2 years LC rate of 29.4 ± 6.9%. The median PFS time was 6.8 ± 0.8 months, with a 1 year PFS rate of 27.2 ± 7.2% (95% CI 14.2-41.9). The median OS time was 10.3 ± 0.5 months (95% CI 7.6-10.4) with a 1 and 2 years OS rate of 22.5 ± 6.7% (95% CI 10.9-36.6). On univariate analysis EOR and RTV were recorded as conditioning LC and survival. These data was confirmed also in multivariate analysis only for RTV (p < 0.01). Recurrent GBM can take advantage of repeated surgery in selected patients with younger age and good clinical status. The entity of surgical resection was confirmed as conditioning survival.
Department of Neurooncological Surgery, Humanitas Cancer Center and Research Hospital, Milan, Italy.
Federico
F
Pessina
Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Milan, Italy.
Pierina
P
Navarria
Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Milan, Italy. Luca.cozzi@humanitas.it.|Department of Biomedical Sciences, Humanitas University, Milan, Italy. Luca.cozzi@humanitas.it.
Luca
L
Cozzi
Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Milan, Italy.
Stefano
S
Tomatis
Department of Neurooncological Surgery, Humanitas Cancer Center and Research Hospital, Milan, Italy.
Marco
M
Riva
Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Milan, Italy.
Anna Maria
AM
Ascolese
Hematology and Oncology, Humanitas Cancer Center and Research Hospital, Milan, Italy.|Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Armando
A
Santoro
Hematology and Oncology, Humanitas Cancer Center and Research Hospital, Milan, Italy.
Matteo
M
Simonelli
Department of Neurooncological Surgery, Humanitas Cancer Center and Research Hospital, Milan, Italy.
Lorenzo
L
Bello
Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Milan, Italy.|Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Marta
M
Scorsetti
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011379:Prognosis; D016896:Treatment Outcome
Prognostic factors; Recurrent glioblastoma multiforme; Surgical resection