Usefulness of Reintervention in Recurrent Glioblastoma: An Indispensable Weapon for Increasing Survival

Publication date: December 2017
Source:World Neurosurgery, Volume 108
Author(s): Juan Delgado-Fernandez, Maria Ángeles Garcia-Pallero, Guillermo Blasco, Juan R. Penanes, Ricardo Gil-Simoes, Paloma Pulido, Rafael G. Sola
BackgroundGlioblastoma is the most frequent primary brain tumor and despite of complete treatment survival is still poor. The aim of this study is to define the utility of reoperation for improving survival in patients with recurrent glioblastoma, and determine other prognostic factors associated with longer survival.MethodsWe performed a retrospective analysis of those patients who underwent surgery and compared those who were operated two or more times and those who received surgery only once. We studied overall survival (OS), progression-free survival (PFS), and clinical variables that could be related with higher survival.ResultsA total of 121 patients were eligible for the study, of whom 31 (25%) underwent reoperation. The reoperation group had a mean and median increase survival of 10.5 and 16.4 months in OS and 3.5 and 2.7 months for PFS compared with the non-reoperation group (P < 0.001 and 0.01, respectively). Although complications were higher in patients that underwent reintervention (19.3%) there was no statistical difference with complication rate in first surgery (12.4%, χ² = 1.86; P = 0.40). Cox multivariable analysis revealed that age (hazard ratio [HR] 1.03; 95% confidence interval [CI], 1.006–1.055; P = 0.013), reoperation (HR, 0.48; 95% CI, 0.285–0.810; P = 0.006), extent of resection >95% (HR, 0.547; 95% CI, 0.401–0.748; P < 0.001), and complete adjuvant therapy (HR, 0.389; 95% CI, 0.208–0.726; P = 0.003) were correlated with a higher OS.ConclusionsReoperation and the extent of resection (EOR) are the only surgical variables that neurosurgeons can modify to improve survival in our patients. Higher EOR and reoperation rates in patients who can be candidates for second surgery, will increase OS and PFS.



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