title: Benefit of re-operation and salvage therapies for recurrent glioblastoma multiforme: results from a single institution.
abstract: The optimal management of recurrent glioblastoma (GBM) has yet to be determined. We aim to assess the benefits of re-operation and salvage therapies (chemotherapy and/or re-irradiation) for recurrent GBM and to identify prognostic factors associated with better survival. All patients who underwent surgery for GBM between January 2005 and December 2012 followed by adjuvant radiotherapy, and who developed GBM recurrence on imaging were included in this retrospective study. Univariate and multivariate analysis was performed using Cox models in order to identify factors associated with overall survival (OS). One hundred and eighty patients treated to a dose of 60 Gy were diagnosed with recurrent GBM. At a median follow-up time of 6.2 months, the median survival (MS) from time of recurrence was 6.6 months. Sixty-nine patients underwent repeat surgery for recurrence based on imaging. To establish the benefits of repeat surgery and salvage therapies, 68 patients who underwent repeat surgery were matched to patients who did not based on extent of initial resection and presence of subventricular zone involvement at recurrence. MS for patients who underwent re-operation was 9.6 months, compared to 5.3 months for patients who did not have repeat surgery (p < 0.0001). Multivariate analysis in the matched pairs confirmed that repeat surgery with the addition of other salvage treatment can significantly affect patient outcome (HR 0.53). Re-operation with additional salvage therapies for recurrent GBM provides survival prolongation at the time of progression.
authors.affiliation: Department of Oncology, Division of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, 1001 Decarie Boulevard, Montréal, QC, H4A 3J1, Canada.
authors.forename: M
authors.identifier: 0000-0002-6568-9844
authors.initials: M
authors.lastname: Azoulay
authors.affiliation: Department of Oncology, Division of Cancer Epidemiology, McGill University, 546 Pine Avenue West, Montréal, QC, H2W 1S6, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Santos
authors.affiliation: Department of Oncology, Division of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, 1001 Decarie Boulevard, Montréal, QC, H4A 3J1, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Shenouda
authors.affiliation: Department of Neurology and Neurosurgery, Montreal Neurological Hospital, McGill University, 3801 University Avenue, Montréal, QC, H3A 2B4, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Petrecca
authors.affiliation: Research Institute of the McGill University Health Center, Montreal General Hospital, 1625 Pine Avenue West, Montréal, QC, H3G 1A4, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Oweida
authors.affiliation: Department of Pathology, Montreal Neurological Hospital, McGill University, 3801 University Avenue, Montréal, QC, H3A 2B4, Canada.
authors.forename: M C
authors.initials: MC
authors.lastname: Guiot
authors.affiliation: Department of Oncology, Division of Medical Oncology, Cedars Cancer Centre, McGill University Health Centre, 1001 Decarie Boulevard, Montréal, QC, H4A 3J1, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Owen
authors.affiliation: Department of Oncology, Division of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, 1001 Decarie Boulevard, Montréal, QC, H4A 3J1, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Panet-Raymond
authors.affiliation: Department of Oncology, Division of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, 1001 Decarie Boulevard, Montréal, QC, H4A 3J1, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Souhami
authors.affiliation: Department of Oncology, Division of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, 1001 Decarie Boulevard, Montréal, QC, H4A 3J1, Canada. bassam.abdulkarim@mcgill.ca.
authors.forename: Bassam S
authors.initials: BS
authors.lastname: Abdulkarim
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D019635:Neurosurgical Procedures; D016016:Proportional Hazards Models; D000069475:Re-Irradiation; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: Bevacizumab; Glioblastoma; Radiation; Recurrence; Surgery; Temozolomide