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The impact of repeated surgery and adjuvant therapy on survival for patients with recurrent glioblastoma.

Al's Comment:

 This study shows that surgery alone for a recurrence of a GBM is not that useful: it adds on average 1 month to survival (compared to the group that had no treatments), and almost half of the patients had major complications from the surgery.

However, combining surgery with chemotherapy gave the best outcome, adding 9 months on average - while chemo alone added only  3 months.

 

This is a small study and apparently wasn't randomized - so we don't know if perhaps people who were in better shape got to get both surgery and chemotherapy, and the patients who were in worse shape got no treatment - which would completely invalidate the results. However, it makes sense that combining the treatments would give the best outcome.  Perhaps adding more of the available treatments, like immunotherapy and tumor treating fields would yield even better results.


Posted on: 09/16/2012

Clin Neurol Neurosurg. 2012 Sep 6. [Epub ahead of print]


The impact of repeated surgery and adjuvant therapy on survival for patients with recurrent glioblastoma.

De Bonis P, Fiorentino A, Anile C, Balducci M, Pompucci A, Chiesa S, Sica G, Lama G, Maira G, Mangiola A.
Source
Institute of Neurosurgery, Catholic University School of Medicine, l.go F. Vito, 1 00168 Rome, Italy.

Abstract
OBJECTIVE:
Treatment of glioblastoma recurrence can have a palliative aim, after considering risks and potential benefits. The aim of this study is to verify the impact of surgery and of palliative adjuvant treatments on survival after recurrence.

METHODS:
From January 2002 to June 2008, we treated 76 consecutive patients with recurrent glioblastoma. Treatment was: 1-surgery alone - 17 patients; 2-adjuvant-therapy alone - 24 patients; 3-surgery and adjuvant therapy - 16 patients; no treatment - 19 patients. The impact on median overall-survival (OS-time between recurrence and death/last follow-up) of age, Karnofsky performance scale (KPS), resection extent and adjuvant treatment scheme (Temozolomide alone vs low-dose fractionated radiotherapy vs others) was determined. Survival curves were obtained through the Kaplan-Meier method. Cox proportional-hazards was used for multivariate analyses. Significance was set at p<0.05.

RESULTS:
Median OS was 7 months. At univariate analysis, patients with a KPS≥70 had a longer OS (9 months vs 5 months -p<0.0001). OS was 6 months for patients treated with surgery alone, 5 months for patients that received no treatment, 8 months for patients treated with chemotherapy alone, 14 months for patients treated with surgery and adjuvant therapy-p=0.01. Patients with a KPS<70 were significantly at risk for death - HR 2.8 -p=0.001. Subgroup analysis showed no significant differences between patients receiving gross total or partial tumor resection and among patients receiving different adjuvant therapy schemes. Major surgical morbidity at tumor recurrence occurred in 16 out of 33 patients (48%).

CONCLUSION:
It is fundamental, before deciding to operate patients for recurrence, to carefully consider the impact of surgical morbidity on outcome.

Copyright © 2012 Elsevier B.V. All rights reserved.

PMID: 22959214 [PubMed - as supplied by publisher]

 


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