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When deciding if reoperation is an option in recurrent glioblastoma, factors like tumor location, therapy history and patient health should be considered.
Prior to reoperation in recurrent glioblastoma, certainfactors should be considered. | © gerasimov174 - stock.adobe.com
Patients with recurrent glioblastoma may derive a survival benefit from reoperation compared with those who did not undergo reoperation, recent study findings suggest.
Results from the study, which were published in the journal “PLOS One”, showed that reoperation in these patients may have contributed to significantly longer disease-free intervals, higher overall survival and progression-free survival rates.
“Based on the data from our patient cohort, we consider redo surgery for patients with recurrent glioblastoma in select cases,” lead study author, Dr. Houssein Darwish, of the Department of Surgery, Division of Neurosurgery, American University of Beirut Medical Center, in Beirut, Lebanon, wrote in the journal article. “Specifically, reoperation should be prioritized in situations where the recurrent lesion is located in a non-eloquent region of the brain, as the risk of significant neurological deficits is minimized. Additionally, reoperation is advised for lesions that are easily accessible surgically, allowing for safer and more effective resections with reduced operative risk.”
According to the American Brain Tumor Association, glioblastomas are cancerous grade 4 tumors that often spread to nearby regions of the brain. Of note, it is rare for glioblastomas to spread outside of the brain and spinal cord, although they may spread to the opposite side of the brain.
In this study, categorizing patients by age (younger versus older than 50 years) and gender did not significantly impact the likelihood of patients undergoing another operation. However, there was an association between a Charlson comorbidity index of three or lower and higher reoperation rates. Of note, tumor size — particularly smaller or bigger than 5 centimeters — was not significantly associated with reoperation status. Other factors that did not significantly impact reoperation rates included whether a tumor was unifocal or multifocal, in addition to the extent of initial tumor resection (gross total resection versus subtotal resection).
A significant factor associated with a patient’s decision to not undergo reoperation was complications following the initial surgery. Some of the most common complications after the initial and subsequent surgeries included weakness, deep vein thrombosis, wound leakage/infection and seizures.
Progression-free survival for patients who underwent reoperation was 15.9 months compared with 6.7 months for those who did not undergoing another operation. Reoperation upon recurrence resulted in a median progression-free survival of 5.9 months versus 5.1 months for those who did not undergo reoperation upon recurrence.
Patients who underwent reoperation had a longer median overall survival compared with those who did not undergo reoperation (21 months versus 11 months).
Researchers went on to compared these findings with other previously published studies, noting that that progression-free survival and overall survival benefits from reoperations may vary.
“Overall, reoperation for recurrent [glioblastoma] appears to offer substantial benefits in terms of both [progression-free survival] and [overall survival] compared to non-reoperation, with [progression-free survival] improvements ranging from a few months to over a year, and [overall survival] improvements similarly varying,” Darwish and other study authors concluded. “The variability in outcomes highlights the importance of personalized treatment planning. Factors such as tumor location, previous treatment history, patient health and the specifics of the surgical approach play crucial roles in determining the effectiveness of reoperation.”
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"Impact of re-operation on progression-free survival in patients with recurrent GBM: Experience in a tertiary referral center" by Dr. Houssein Darwish, et al., PLOS One.