Multiple surgical resections for progressive IDH wildtype glioblastoma-is it beneficial?

Autor: Honeyman SI; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. susan.honeyman@ouh.nhs.uk., Owen WJ; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Mier J; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Marks K; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Dassanyake SN; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Wood MJ; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Fairhead R; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Martinez-Soler P; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Jasem H; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Yarlagadda A; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Roach JR; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Boukas A; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Stacey R; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Apostolopoulos V; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Plaha P; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.; Nuffield Department of Surgery, University of Oxford, Oxford, UK.; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Jazyk: angličtina
Zdroj: Acta neurochirurgica [Acta Neurochir (Wien)] 2024 Mar 15; Vol. 166 (1), pp. 138. Date of Electronic Publication: 2024 Mar 15.
DOI: 10.1007/s00701-024-06025-x
Abstrakt: Purpose: The role of repeat resection for recurrent glioblastoma (rGB) remains equivocal. This study aims to assess the overall survival and complications rates of single or repeat resection for rGB.
Methods: A single-centre retrospective review of all patients with IDH-wildtype glioblastoma managed surgically, between January 2014 and January 2022, was carried out. Patient survival and factors influencing prognosis were analysed, using Kaplan-Meier and Cox regression methods.
Results: Four hundred thirty-two patients were included, of whom 329 underwent single resection, 83 had two resections and 20 patients underwent three resections. Median OS (mOS) in the cohort who underwent a single operation was 13.7 months (95% CI: 12.7-14.7 months). The mOS was observed to be extended in patients who underwent second or third-time resection, at 22.9 months and 44.7 months respectively (p < 0.001). On second operation achieving > 95% resection or residual tumour volume of < 2.25 cc was significantly associated with prolonged survival. There was no significant difference in overall complication rates between primary versus second (p = 0.973) or third-time resections (p = 0.312). The use of diffusion tensor imaging (DTI) guided resection was associated with reduced post-operative neurological deficit (RR 0.37, p = 0.002), as was use of intraoperative ultrasound (iUSS) (RR 0.45, p = 0.04).
Conclusions: This study demonstrates potential prolongation of survival for rGB patients undergoing repeat resection, without significant increase in complication rates with repeat resections. Achieving a more complete repeat resection improved survival. Moreover, the use of intraoperative imaging adjuncts can maximise tumour resection, whilst minimising the risk of neurological deficit.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: