Repeat glioblastoma surgeries may prolong life

Persons with glioblastoma who undergo repeated resections can have improved survival, indicate the findings of a recent study.

The most common and aggressive type of primary brain tumor in adults, glioblastoma recurs regardless of intervention. This propensity to recur despite aggressive therapies has made many perceive that repeated resections are of little use, explained investigators Alfredo Quiñones-Hinojosa, MD, a neurosurgeon at the Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues, in Journal of Neurosurgery.

To evaluate whether patients with glioblastoma experienced improved survival if they had repeated surgeries, the researchers retrospectively reviewed records of 578 adults who underwent surgery for an intracranial primary glioblastoma at one facility between 1997 and 2007. At the last follow-up recorded by Quiñones-Hinojosa's group:

  • 354 patients had undergone one resection; median survival was 6.8 months
  • 168 patients had undergone two resections; median survival was 15.5 months
  • 41 patients had undergone three resections median survival was 22.4 months
  • 15 patients had undergone four resections; median survival was 26.6 months.

The risk of infections or iatrogenic deficits did not increase with repeated resections.

The investigators used strict inclusion criteria, multivariate analyses, and case-control evaluation. Nevertheless, in a statement issued by Johns Hopkins Medicine, Quiñones-Hinojosa cautioned that his group's analysis may overestimate the value of multiple surgeries based on patient selection, and that patients who did better may have had tumors with a biology that predisposed those individuals to live longer. Further research would be needed to confirm or refute these results.

He also noted that because glioblastomas become so deeply intertwined with healthy brain tissue, they are difficult to remove. With each successive surgery, the procedure itself becomes more technically challenging due to anatomical changes, damaged blood vessels, and frail tissues. However, “The only thing that has proven to work for glioblastoma throughout history is surgery,” Quiñones-Hinojosa pointed out. “Without surgery, these patients don't have much of a chance.”

The authors concluded that despite the possible limitations of their study, patients with recurrent glioblastomas can have improved survival with repeated resections.

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