Impact of recurrence pattern in patients undergoing a second surgery for recurrent glioblastoma

Abstract Background. The impact of different patterns of glioblastoma (GBM) recurrence has not yet been fully established in patients suitable for a second surgery. Through the present observational study carried out at Pisa University Hospital, we aimed to examine the impact of different patterns of GBM failure on patients’ survival and second surgery outcomes.Methods. Overall survival was assessed according to clinical characteristics, including pattern of recurrence, in a prospective cohort of recurrent GBM patients. Survival curves were calculated using the Kaplan-Meier method and the log-rank test was applied to evaluate the differences between curves.Results. Contact with ventricles, a second surgery and meningeal spread had a statistically impact on patient survival after the diagnosis of GBM recurrence (P=0.032, P=0.019 and P<0.01, respectively). Patients with local recurrence had better survival than patients with non-local ones, 24.1 versus 18.2 months, respectively (P=0.015, HR=1.856 (1.130 -3.050). Considering the cohort as a whole, the second surgery conferred an advantage in recurrent survival respect to non-operated patients. However, this advantage was more evident in patients with local recurrence (P=0.002 with HR 0.212 (95% CI 0.081-0.552) and P=0.029 with HR=0.522 (95% CI 0.291-0.936), respectively). Conclusions. The local recurrence pattern could be a promising field of interest for patients with recurrent GBM suitable for a second surgery.

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P14.56 Recurrent Glioblastomas: Should we operate a second and even a third time

Neuro-Oncology ◽

10.1093/neuonc/noz126.291 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii80-iii80

Author(s):

M Yahia-Cherif ◽

O De Witte ◽

C Mélot ◽

F Lefranc

Keyword(s):

Overall Survival ◽

Survival Benefit ◽

Standard Of Care ◽

Recurrent Glioblastoma ◽

Kaplan Meier ◽

Significant Survival ◽

Significant Difference ◽

Second Surgery ◽

Second Resection ◽

Initial Resection

Abstract BACKGROUND The aim of this study was i) to analyse the effect of repeat surgeries on the survival of patients with focally recurrent glioblastoma who have benefited from temozolomide treatment and ii) to identify potential prognostic factors for survival. MATERIAL AND METHODS Cases from 2005 to 2014 in the glioblastoma database of our department were retrospectively reviewed. The Kaplan-Meier method was used to estimate overall survival (OS) as a function of time after one, two and three surgical resections. All patients received the standard of care after the first surgery (temozolomide during and after radiotherapy) and adjuvant treatment after repeat surgeries. RESULTS One hundred-thirty-two glioblastoma patients (median age: 57 years) were included in the study. Among them, 68, 53 and 11 patients underwent one, two and three surgical resections, respectively. The median OS was 11, 16 and 18 months, respectively, for patients who underwent one, two and three surgical resections. Patients who underwent two (p<0.001) or three (p<0.01) surgeries survived significantly longer than patients who underwent only one. No significant difference was observed between patients who underwent two versus three surgeries (p=0.76). A second resection performed more than 6 months after the initial resection was the only factor associated with prolonged survival (p=0.008). CONCLUSION Glioblastoma patients who benefited from temozolomide treatment and underwent surgery for recurrent glioblastoma exhibited a significant increase in survival compared with patients who did not undergo a second surgery. By contrast, a third surgery for a second recurrence did not contribute to any significant survival benefit.

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Outcomes after second surgery for recurrent glioblastoma: a retrospective case–control study

Journal of Neuro-Oncology ◽

10.1007/s11060-017-2731-2 ◽

2018 ◽

Vol 137 (2) ◽

pp. 409-415 ◽

Cited By ~ 15

Author(s):

Alysson Wann ◽

Patrick A. Tully ◽

Elizabeth H. Barnes ◽

Zarnie Lwin ◽

Rosalind Jeffree ◽

...

Keyword(s):

Case Control Study ◽

Case Control ◽

Recurrent Glioblastoma ◽

Retrospective Case ◽

Second Surgery ◽

Control Study

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Second surgery for recurrent glioblastoma: A concise overview of the current literature

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2016.01.010 ◽

2016 ◽

Vol 142 ◽

pp. 60-64 ◽

Cited By ~ 27

Author(s):

Nicola Montemurro ◽

Paolo Perrini ◽

Magdalena Olivares Blanco ◽

Riccardo Vannozzi

Keyword(s):

Current Literature ◽

Recurrent Glioblastoma ◽

Concise Overview ◽

Second Surgery

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SURG-06. OUTCOMES OF SECOND SURGERY FOR RECURRENT GLIOBLASTOMA MULTIFORME: A RETROSPECTIVE CASE CONTROL STUDY

Neuro-Oncology ◽

10.1093/neuonc/now212.807 ◽

2016 ◽

Vol 18 (suppl_6) ◽

pp. vi192-vi192

Author(s):

Alysson Wann ◽

Patrick Tully ◽

Liz Barnes ◽

Zarnie Lwin ◽

Lindy Jeffree ◽

...

Keyword(s):

Glioblastoma Multiforme ◽

Case Control Study ◽

Case Control ◽

Recurrent Glioblastoma ◽

Recurrent Glioblastoma Multiforme ◽

Retrospective Case ◽

Second Surgery ◽

Control Study

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Which patients with recurrent glioblastoma will require a second surgery during their treatment? A machine learning solution

Annals of Oncology ◽

10.1093/annonc/mdx366.027 ◽

2017 ◽

Vol 28 ◽

pp. v118

Author(s):

A. Ruiz-Patiño ◽

A.F. Cardona ◽

L. Rojas ◽

O. Arrieta ◽

Z. Zatarain-Barrón

Keyword(s):

Machine Learning ◽

Recurrent Glioblastoma ◽

Second Surgery

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2918 Preliminary experiences of second surgery combined with postoperative systemic therapy in patients with recurrent Glioblastoma

European Journal of Cancer ◽

10.1016/s0959-8049(16)31633-1 ◽

2015 ◽

Vol 51 ◽

pp. S590

Author(s):

D. Delishaj ◽

F. Pasqualetti ◽

D. Caramella ◽

L.R. Fatigante ◽

F. Matteucci ◽

...

Keyword(s):

Systemic Therapy ◽

Recurrent Glioblastoma ◽

Second Surgery

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Second surgery for recurrent glioblastoma: advantages and pitfalls

Expert Review of Anticancer Therapy ◽

10.1586/era.13.32 ◽

2013 ◽

Vol 13 (5) ◽

pp. 583-587 ◽

Cited By ~ 16

Author(s):

Alba A Brandes ◽

Marco Bartolotti ◽

Enrico Franceschi

Keyword(s):

Recurrent Glioblastoma ◽

Second Surgery

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The Combination of Carmustine Wafers and Fotemustine in Recurrent Glioblastoma Patients: A Monoinstitutional Experience

BioMed Research International ◽

10.1155/2014/678191 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Giuseppe Lombardi ◽

Alessandro Della Puppa ◽

Fable Zustovich ◽

Ardi Pambuku ◽

Patrizia Farina ◽

...

Keyword(s):

Progression Free Survival ◽

Recurrent Glioblastoma ◽

Gross Total Resection ◽

Total Resection ◽

Free Survival ◽

Multimodal Strategy ◽

Carmustine Wafers ◽

Second Surgery ◽

Grade 3 ◽

Clinical Conditions

Background. To date, there is no standard treatment for recurrent glioblastoma. We analyzed the feasibility of second surgery plus carmustine wafers followed by intravenous fotemustine.Methods. Retrospectively, we analyzed patients with recurrent glioblastoma treated with this multimodal strategy.Results. Twenty-four patients were analyzed. The median age was 53.6; all patients had KPS between 90 and 100; 19 patients (79%) performed a gross total resection > 98% and 5 (21%) a gross total resection > 90%. The median progression-free survival from second surgery was 6 months (95% CI 3.9–8.05) and the median OS was 14 months (95% CI 11.1–16.8 months). Toxicity was predominantly haematological: 5 patients (21%) experienced grade 3-4 thrombocytopenia and 3 patients (12%) grade 3-4 leukopenia.Conclusion. This multimodal strategy may be feasible in patients with recurrent glioblastoma, in particular, for patients in good clinical conditions.

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