SURG-07. STEREOTACTIC LASER ABLATION AS A THERAPEUTIC OPTION FOR RECURRENT GLIOBLASTOMA: A LARGE SINGLE INSTITUTIONAL EXPERIENCE

Abstract INTRODUCTION The prognosis of patients diagnosed with recurrent glioblastoma remains dismal, and therapeutic options are limited. The median survival is only 3 to 5 months. Stereotactic laser ablation is a minimally invasive neurosurgical technique used as an ablative treatment. We report outcomes of a large single institutional patient database of recurrent glioblastoma treated with laser ablation. METHODS Patients with recurrent glioblastoma, previously treated with biopsy or surgical resection plus standard radiation/temozolomide (and any other additional therapies), who underwent laser ablation with the NeuroBlate system at The Cleveland Clinic were retrospectively reviewed from 2011 through 2017. Primary endpoints were progression free survival (PFS) and overall survival (OS). RESULTS Between 2011 and 2017, 31 patients with recurrent glioblastoma were treated with laser ablation out of more than 250 laser ablation cases for brain tumors. This population included 17 males and 14 females. Age at the time of diagnosis ranged from 27 to 77. 84% underwent surgical resection as the initial treatment. 65% were treated with laser ablation after the first recurrence of previously treated glioblastoma. The average number of postoperative hospital days was 2.8, and most patients went home. 54% remained neurologically stable without new postoperative deficits, and 52% had no reported change in Karnofsky Performance Scale from before to after laser ablation. Median PFS was 5 months, and median OS was 13 months. CONCLUSIONS Laser ablation has been used to treat various intracranial lesions at The Cleveland Clinic, particularly recurrent glioblastoma. This treatment modality can be utilized at any point of recurrence in patients with appropriate clinical and radiographic characteristics. In addition, the minimally invasive nature and relatively short hospital stay in comparison to surgical tumor resection make laser ablation favorable. Laser ablation is becoming a valuable tool in a multidisciplinary approach to treat recurrent glioblastoma.

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Safety and efficacy of permanent iodine-125 seed implants and carmustine wafers in patients with recurrent glioblastoma multiforme

Journal of Neurosurgery ◽

10.3171/jns/2008/108/2/0236 ◽

2008 ◽

Vol 108 (2) ◽

pp. 236-242 ◽

Cited By ~ 35

Author(s):

Borimir J. Darakchiev ◽

Robert E. Albright ◽

John C. Breneman ◽

Ronald E. Warnick

Keyword(s):

Glioblastoma Multiforme ◽

Treatment Options ◽

Tumor Resection ◽

Progression Free Survival ◽

Recurrent Glioblastoma ◽

Karnofsky Performance Scale ◽

Recurrent Glioblastoma Multiforme ◽

Brain Necrosis ◽

Bcnu Wafers ◽

Recurrent Gbm

Object Effective treatment options are limited for patients with recurrent glioblastoma multiforme (GBM), and survival is usually <1 year. Novel treatment approaches are needed. Localized adjunct treatment with carmustine (BCNU) wafers or permanent, low-activity 125I seed implants has been shown to be effective for GBM. This study assessed the efficacy and safety of these therapies in combination following tumor resection. Methods Thirty-four patients with recurrent GBM were treated with maximal tumor resection followed by implantation of BCNU wafers and permanent 125I seeds into the tumor cavity. Patients were followed up with clinical evaluations and magnetic resonance imaging studies once every 3 months. Survival and progression-free survival (PFS) were evaluated. Results During follow-up, local disease progression was observed in 27 patients, and 23 of them died. The median survival period was 69 weeks, and the median PFS was 47 weeks. The 12-month survival and PFS rates were 66 and 32%, respectively. Baseline factors associated with prolonged survival included Karnofsky Performance Scale score ≥ 70, 125I seed activity ≥ 0.8 mCi/cm3 of tumor cavity, and age < 60 years. Brain necrosis developed in 8 patients (24%) and was successfully treated with surgery or hyperbaric oxygen therapy. Conclusions The use of adjunct therapy combining BCNU wafers and permanent 125I seeds resulted in survival that compares favorably with data from similar studies performed in patients with recurrent GBM. The incidence of brain necrosis appeared to be higher than that expected with either treatment alone, although the necrosis was manageable and did not affect survival. This novel approach warrants further investigation in recurrent and newly diagnosed GBM.

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Machine-Learning-Based Radiomics MRI Model for Survival Prediction of Recurrent Glioblastomas Treated with Bevacizumab

Diagnostics ◽

10.3390/diagnostics11071263 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1263

Author(s):

Samy Ammari ◽

Raoul Sallé de Chou ◽

Tarek Assi ◽

Mehdi Touat ◽

Emilie Chouzenoux ◽

...

Keyword(s):

Machine Learning ◽

Therapeutic Option ◽

Binary Classification ◽

Progression Free Survival ◽

Recurrent Glioblastoma ◽

Machine Learning Algorithms ◽

Survival Prediction ◽

Classification Models ◽

Angiogenic Therapy ◽

Recurrent Gbm

Anti-angiogenic therapy with bevacizumab is a widely used therapeutic option for recurrent glioblastoma (GBM). Nevertheless, the therapeutic response remains highly heterogeneous among GBM patients with discordant outcomes. Recent data have shown that radiomics, an advanced recent imaging analysis method, can help to predict both prognosis and therapy in a multitude of solid tumours. The objective of this study was to identify novel biomarkers, extracted from MRI and clinical data, which could predict overall survival (OS) and progression-free survival (PFS) in GBM patients treated with bevacizumab using machine-learning algorithms. In a cohort of 194 recurrent GBM patients (age range 18–80), radiomics data from pre-treatment T2 FLAIR and gadolinium-injected MRI images along with clinical features were analysed. Binary classification models for OS at 9, 12, and 15 months were evaluated. Our classification models successfully stratified the OS. The AUCs were equal to 0.78, 0.85, and 0.76 on the test sets (0.79, 0.82, and 0.87 on the training sets) for the 9-, 12-, and 15-month endpoints, respectively. Regressions yielded a C-index of 0.64 (0.74) for OS and 0.57 (0.69) for PFS. These results suggest that radiomics could assist in the elaboration of a predictive model for treatment selection in recurrent GBM patients.

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CTIM-03. PHASE II STUDY OF REGORAFENIB IN BEVACIZUMAB REFRACTORY RECURRENT GLIOBLASTOMA

Neuro-Oncology ◽

10.1093/neuonc/noaa215.137 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii33-ii33

Author(s):

Yasmeen Rauf ◽

Cathy Schilero ◽

David Peereboom ◽

Manmeet Ahluwalia

Keyword(s):

Dose Escalation ◽

Therapeutic Option ◽

Objective Response ◽

Progression Free Survival ◽

Recurrent Glioblastoma ◽

Weekly Dose ◽

Cellular Functions ◽

Molecule Inhibitor ◽

Secondary Endpoints ◽

Magnetic Resonance Imaging Mri

Abstract BACKGROUND Most patients with glioblastoma (GBM) receive bevacizumab as part of their treatment. There is no good therapeutic option after bevacizumab failure. Regorafenib has potent preclinical antitumor activity and long-lasting anti-angiogenic activity as measured by dynamic contrast enhanced (DCE) – magnetic resonance imaging (MRI). Regorafenib is a small molecule inhibitor of multiple membrane-bound and intracellular kinases involved in normal cellular functions and in pathologic processes such as oncogenesis, tumor angiogenesis, and maintenance of the tumor microenvironment. METHODS Patients with progression of GBM after treatment with Bevacizumab will be eligible for the study. Oral administration of Regorafenib at 160 mg once daily will be administered for 3 weeks on /1 week off. Weekly dose escalation of regorafenib from 80 mg to 160 mg/day will be employed as per the Redos strategy. Patients start the treatment 80 mg/day in week 1, with weekly dose escalation to 120 mg in week 2, then 160 mg week in 3 if no significant drug-related toxicities are observed. They will be continued on treatment with Regorafenib 160 md /day till tumor progression or toxicity. They will get MRI brain every 4 weeks during the study. RESULTS Primary endpoint is median Overall survival. Secondary endpoints include progression free survival at 6 months and the median time to progression and objective response rate using the modified RANO criteria. The overall safety and tolerability of regorafenib by CTCAE version 5.0. will also be reported. CONCLUSION This is an ongoing clinical trial.

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SURG-13. LASER INTERSTITIAL THERMAL THERAPY FOR RECURRENT GLIOBLASTOMA: A REVIEW OF SURVIVAL OUTCOMES COMPARED TO A MATCHED SURGICAL COHORT

Neuro-Oncology ◽

10.1093/neuonc/noaa215.860 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii206-ii206

Author(s):

Hassan Fadel ◽

Sameah Haider ◽

Jacob Pawloski ◽

Hesham Zakaria ◽

Farhan Chaudhry ◽

...

Keyword(s):

Surgical Resection ◽

Subgroup Analysis ◽

Tumor Volume ◽

Progression Free Survival ◽

Recurrent Glioblastoma ◽

Thermal Therapy ◽

Survival Outcomes ◽

Repeat Surgery ◽

Laser Interstitial Thermal Therapy ◽

Recurrent Gbm

Abstract INTRODUCTION Glioblastoma (GBM) is uniformly associated with a poor prognosis and inevitable recurrence. Management of recurrent GBM remains unclear, with repeat surgery often employed with varying degrees of success. We evaluated the efficacy of Laser Interstitial Thermal Therapy (LITT) for recurrent GBM when compared to a carefully matched cohort of patients treated with repeat surgical resection. METHODS A retrospective single-institution database was used to identify patients who underwent LITT or surgical resection of recurrent GBM between 2014-2019. LITT patients were matched with surgical resection patients according to baseline demographics, comorbidities, tumor location, and eloquence. Subgroup analysis matching similar patients for tumor volume was also completed. Overall survival (OS) and progression-free survival (PFS) were the primary endpoints. RESULTS A LITT cohort of 20 patients was matched to 50 similar patients who underwent repeat surgical resection. Baseline characteristics were similar between both cohorts apart from tumor volume, which was larger in the surgical cohort (17.5 cc vs. 4.7 cc, p< 0.01). On long-term follow-up, there was no difference in OS (HR, 0.72; 95%CI, 0.36-1.45) or PFS (HR, 0.67; 95%CI, 0.29-1.53) between the LITT and surgical cohorts when controlling for tumor volume. Subgroup analysis of 23 LITT patients matched according to tumor volume with 23 surgical patients with similar clinical characteristics also found no difference in OS (HR, 0.66; 95%CI, 0.33-1.30) or PFS (HR, 0.58; 95%CI, 0.90-1.05) between the cohorts. LITT patients had shorter length of stays (1 vs. 4 days, p< 0.001) and a higher rate of home discharge (84% vs. 67%, p=0.172) compared to the surgical cohort. CONCLUSION After matching for demographic, clinical, and tumor characteristics, there was no difference in outcomes between patients undergoing LITT compared to surgical resection for recurrent GBM. LITT patients had similar survival outcomes yet shorter hospital stays and more favorable dispositions, potentially mitigating post-treatment complications.

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Upfront Magnetic Resonance Imaging-Guided Stereotactic Laser-Ablation in Newly Diagnosed Glioblastoma: A Multicenter Review of Survival Outcomes Compared to a Matched Cohort of Biopsy-Only Patients

Neurosurgery ◽

10.1093/neuros/nyy449 ◽

2018 ◽

Vol 85 (6) ◽

pp. 762-772 ◽

Cited By ~ 15

Author(s):

Alireza M Mohammadi ◽

Mayur Sharma ◽

Thomas L Beaumont ◽

Kevin O Juarez ◽

Hanna Kemeny ◽

...

Keyword(s):

Laser Ablation ◽

Tumor Volume ◽

Cleveland Clinic ◽

Damage Threshold ◽

Progression Free Survival ◽

Tumor Location ◽

Newly Diagnosed ◽

Prognostic Groups ◽

Newly Diagnosed Glioblastoma ◽

Disease Specific

Abstract BACKGROUND Laser ablation (LA) is used as an upfront treatment in patients with deep seated newly diagnosed Glioblastoma (nGBM). OBJECTIVE To evaluate the outcomes of LA in patients with nGBM and compare them with a matched biopsy-only cohort. METHODS Twenty-four nGBM patients underwent upfront LA at Cleveland clinic, Washington University in St. Louis, and Yale University (6/2011-12/2014) followed by chemo/radiotherapy. Also, 24 out of 171 nGBM patients with biopsy followed by chemo/radiotherapy were matched based on age (< 70 vs ≥ 70), gender, tumor location (deep vs lobar), and volume (<11 cc vs ≥11 cc). Progression-free survival (PFS), overall survival (OS), and disease-specific PFS and OS were outcome measures. Three prognostic groups were identified based on extent of tumor ablation by thermal-damage-threshold (TDT)-lines. RESULTS The median tumor volume in LA (n = 24) and biopsy only (n = 24) groups was 9.3 cm3 and 8.2 cm3 respectively. Overall, median estimate of OS and PFS in LA cohort was 14.4 and 4.3 mo compared to 15.8 mo and 5.9 mo for biopsy only cohort. On multivariate analysis, favorable TDT-line prognostic groups were associated with lower incidence of disease specific death (P = .03) and progression (P = .05) compared to other groups including biopsy only cohort. Only age (<70 yr, P = .02) and tumor volume (<11 cc, P = .03) were favorable prognostic factors for OS. CONCLUSION The maximum tumor coverage by LA followed by radiation/chemotherapy is an effective treatment modality in patients with nGBM, compared to biopsy only cohort. The TDT-line prognostic groups were independent predictor of disease specific death and progression after LA.

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Efficacy of panitumumab plus irinotecan versus cetuximab plus irinotecan in patients with wild-type KRAS exon2 metastatic colorectal cancer previously treated with bevacizumab within 6 months.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.800 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 800-800 ◽

Cited By ~ 1

Author(s):

Kaori Hayashi ◽

Seiichiro Mitani ◽

Hiroya Taniguchi ◽

Satoshi Hamauchi ◽

Keiji Sugiyama ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Short Interval ◽

Tumor Resection ◽

Progression Free Survival ◽

Interval Methods ◽

Inclusion Criteria ◽

Wild Type ◽

Previously Treated ◽

Ecog Ps

800 Background: The ASPECCT study showed panitumumab (Pmab) is non-inferior to cetuximab (Cmab) for chemotherapy-refractory and intolerant wild-type (WT) KRAS exon2 metastatic colorectal cancer (mCRC). In the subgroup analysis, Pmab provided more favorable outcomes than Cmab for patients (pts) previously treated with bevacizumab (Bmab). However, some reports suggested that anti-EGFR antibody (anti-EGFR) efficacy was reduced when received within 6 months of last administration of Bmab. In this study, we aim to evaluate the difference in efficacy between Pmab and Cmab in pts who received prior Bmab and were treated with anti-EGFR after a short interval. Methods: We retrospectively evaluated pts treated with anti-EGFR and irinotecan (IRI) after failure of Bmab, fluoropyrimidine, oxaliplatin, and IRI at two institutions. The main inclusion criteria were WT KRAS exon2 mCRC, ECOG PS 0-2, and no prior administration of anti-EGFR within 6 months after Bmab. Results: From Sep. 2008 to Mar. 2016, 124 consecutive pts met the inclusion criteria (Pmab/Cmab, 30/94). Pts’ characteristics were as follows (Pmab/Cmab): median age (range): 63/62 (38-76/27-82); male, 63%/72%; ECOG PS 0, 43%/27%; PS1, 57%/66%; PS2 0%/7%; tumor in left colon, 87%/76%; histology (por, muc), 10%/16%; ≥2 metastases, 67%/66%; ≥1 subsequent therapy, 73%/63%. Overall response and disease control rates in Pmab/Cmab were 31%/26% and 69%/67%, respectively. In Pmab/Cmab, the median overall survival was 15.8/12.2 months (HR, 0.62; 95% CI, 0.4-0.97; P=0.04) and the median progression-free survival was 6.5/5.5 months (HR, 0.75; 95% CI, 0.49-1.16, P=0.20). The adjusted HR with 10 covariates such as age, gender, PS, tumor location, histology, primary tumor resection, number of metastatic sites, liver limited disease, time from diagnosis of metastasis and initiation date of anti-EGFR plus IRI was 0.61 for PFS (p=0.1) and 0.61 for OS (p=0.04). Conclusions: Pmab plus irinotecan showed favorable outcomes compared with Cmab plus irinotecan in pts with WT KRAS exon2 mCRC within 6 months between the last administration of Bmab and initial anti-EGFR.

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Outcomes and prognostic stratification of patients with recurrent glioblastoma treated with salvage stereotactic radiosurgery

Journal of Neurosurgery ◽

10.3171/2018.4.jns172909 ◽

2019 ◽

Vol 131 (2) ◽

pp. 489-499 ◽

Cited By ~ 3

Author(s):

Mayur Sharma ◽

Jason L. Schroeder ◽

Paul Elson ◽

Antonio Meola ◽

Gene H. Barnett ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Performance Status ◽

Progression Free Survival ◽

Recurrent Glioblastoma ◽

Karnofsky Performance Scale ◽

Tumor Diameter ◽

Homogeneity Index ◽

Average Survival ◽

Prognostic Stratification ◽

Treatment Plans

OBJECTIVEGlioblastoma (GBM) is the most malignant form of astrocytoma. The average survival is 6–10 months in patients with recurrent GBM (rGBM). In this study, the authors evaluated the role of stereotactic radiosurgery (SRS) in patients with rGBMs.METHODSThe authors performed a retrospective review of their brain tumor database (1997–2016). Overall survival (OS) and progression-free survival (PFS) after salvage SRS were the primary endpoints evaluated. Response to SRS was assessed using volumetric MR images.RESULTSFifty-three patients with rGBM underwent salvage SRS targeting 75 lesions. The median tumor diameter and volume were 2.55 cm and 3.80 cm3, respectively. The median prescription dose was 18 Gy (range 12–24 Gy) and the homogeneity index was 1.90 (range 1.11–2.02). The median OS after salvage SRS was estimated to be 11.0 months (95% CI 7.1–12.2) and the median PFS after salvage SRS was 4.4 months (95% CI 3.7–5.0). A Karnofsky Performance Scale score ≥ 80 was independently associated with longer OS, while small tumor volume (< 15 cm3) and less homogeneous treatment plans (homogeneity index > 1.75) were both independently associated with longer OS (p = 0.007 and 0.03) and PFS (p = 0.01 and 0.002, respectively). Based on these factors, 2 prognostic groups were identified for PFS (5.4 vs 3.2 months), while 3 were identified for OS (median OS of 15.2 vs 10.5 vs 5.2 months).CONCLUSIONSSRS is associated with longer OS and/or PFS in patients with good performance status, small-volume tumor recurrences, and heterogeneous treatment plans. The authors propose a prognostic model to identify a cohort of rGBM patients who may benefit from SRS.

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Re-irradiation of recurrent glioblastoma using helical TomoTherapy with simultaneous integrated boost: preliminary considerations of treatment efficacy

Scientific Reports ◽

10.1038/s41598-020-75671-9 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Donatella Arpa ◽

Elisabetta Parisi ◽

Giulia Ghigi ◽

Alessandro Savini ◽

Sarah Pia Colangione ◽

...

Keyword(s):

Helical Tomotherapy ◽

Therapeutic Option ◽

Progression Free Survival ◽

Late Toxicity ◽

Recurrent Glioblastoma ◽

Simultaneous Integrated Boost ◽

Recurrent Glioblastoma Multiforme ◽

Recovery Planning ◽

Integrated Boost ◽

Fluid Attenuated Inversion Recovery

Abstract Although there is still no standard treatment for recurrent glioblastoma multiforme (rGBM), re-irradiation could be a therapeutic option. We retrospectively evaluated the efficacy and safety of re-irradiation using helical TomoTherapy (HT) with a simultaneous integrated boost (SIB) technique in patients with rGBM. 24 patients with rGBM underwent HT-SIB. A total dose of 20 Gy was prescribed to the Flair (fluid-attenuated inversion recovery) planning tumor volume (PTV) and 25 Gy to the PTV-boost (T1 MRI contrast enhanced area) in 5 daily fractions to the isodose of 67% (maximum dose within the PTV-boost was 37.5 Gy). Toxicity was evaluated by converting the 3D-dose distribution to the equivalent dose in 2 Gy fractions on a voxel-by-voxel basis. Median follow-up after re-irradiation was 27.8 months (range 1.6–88.5 months). Median progression-free survival (PFS) was 4 months (95% CI 2.0–7.9 months), while 6-month PFS was 41.7% (95% CI 22.2–60.1 months). Median overall survival following re-irradiation was 10.7 months (95% CI 7.4–16.1 months). There were no cases of re-operation due to early or late toxicity. Our preliminary results suggest that helical TomoTherapy with the proposed SIB technique is a safe and feasible treatment option for patients with rGBM, including those large disease volumes, reducing toxicity.

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Pineoblastoma—The Experience at St. Jude Children's Research Hospital

Neurosurgery ◽

10.1093/neuros/nyx005 ◽

2017 ◽

Vol 81 (1) ◽

pp. 120-128 ◽

Cited By ~ 20

Author(s):

Kara A. Parikh ◽

Garrett T. Venable ◽

Brent A. Orr ◽

Asim F. Choudhri ◽

Frederick A. Boop ◽

...

Keyword(s):

Surgical Resection ◽

Metastatic Disease ◽

Tumor Resection ◽

Progression Free Survival ◽

Subtotal Resection ◽

Total Resection ◽

Research Hospital ◽

Tumor Relapse ◽

The Impact

Abstract BACKGROUND: Pineoblastomas are rare, supratentorial, primitive neuroectodermal tumors. OBJECTIVE: To document outcomes with multimodal therapy and evaluate the impact that the degree of surgical resection has on outcome. METHODS: A departmental brain tumor database was queried to identify all patients with pathologically proven pineoblastoma who were treated from January 1997 to June 2015 at St. Jude Children's Research Hospital. For each patient, we recorded demographic, pathological, radiological, surgical, and clinical follow-up data. The effect of degree of surgical resection on survival outcomes was analyzed. RESULTS: Forty-one patients (21 male, 20 female) treated for pineoblastoma were identified. The median age at diagnosis was 5.5 years (range 0.4-28.1) and the median follow-up was 34.5 months. Nineteen patients experienced tumor relapse with a median progression-free survival of 11.3 months, and 18 ultimately succumbed to their disease. Patients who died or experienced treatment failure were younger (median, 2.69 vs 6.5 years, P = .026) and more likely to have metastatic disease at diagnosis (12 [63.2%] vs 5 [22.7%], P = .012). When analyzing only patients 5 years of age or older with focal disease at presentation, those who had a gross total resection or near-total resection—compared with subtotal resection or biopsy—had greater overall survival (75.18 vs 48.57 months), with no patients dying as a result of their cancer. CONCLUSION: Poor prognostic variables for children with pineoblastoma include young age, metastatic disease at presentation, and tumor relapse. For patients older than 5 years with focal disease, maximal tumor resection should be the goal.

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STMO-21 The Outcome of tumor resection followed by photodynamic therapy for recurrent glioblastoma

Neuro-Oncology Advances ◽

10.1093/noajnl/vdab159.053 ◽

2021 ◽

Vol 3 (Supplement_6) ◽

pp. vi14-vi14

Author(s):

Tatsuya Kobayashi ◽

Masayuki Nitta ◽

Kazuhide Shimizu ◽

Taiichi Saito ◽

Takashi Maruyama ◽

...

Keyword(s):

Photodynamic Therapy ◽

Prognostic Factors ◽

Treatment Options ◽

Tumor Resection ◽

Recurrent Glioblastoma ◽

Control Group ◽

Karnofsky Performance Scale ◽

Lower Grade ◽

Talaporfin Sodium ◽

Significant Difference

Abstract Recurrent glioblastoma remains a clinical problem with no standard treatment and quite a few effective treatment options. We evaluated the efficacy of photodynamic therapy (PDT) using talaporfin sodium (TS) as a treatment for recurrent glioblastoma in a retrospective analysis of 70 patients who underwent PDT with surgery (PDT group) between 2014 and 2018, and 38 patients who underwent surgery alone (control group) during the same period. The median overall survival (OS) of the PDT and control groups were 16.03 and 12.75 months, respectively (P=0.0311). The median progression-free survival (PFS) of these two groups were 5.67 and 2.2 months, respectively (P=0.00428). Univariate and multivariate analyses showed PDT with surgery and preoperative Karnofsky Performance Scale as significant independent prognostic factors for both PFS and OS.On the other hand, IDH mutation and previous pathology before recurrence were not significant prognostic factors in this study. In the PDT group, there was no significant difference in PFS and OS between patients with GBM from the previous pathology before recurrence and those with malignant transformation to GBM from lower-grade glioma. Furthermore, there was also no significant difference in TS accumulation in the tumor between these two groups. These results suggest that additional PDT treatment for recurrent glioblastoma can have potential survival benefits and that its efficacy is independent of the pathology before recurrence or IDH status.

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