Extent of Resection at Repeat Craniotomy for Recurrent Glioblastoma Predicts Overall Survival

Orin Bloch, MD1, Seunggu Han, MD1, Gurvinder Kaur, BS1, Manish Aghi, MD, PhD1, Michael McDermott, MD1, Mitchel Berger, MD1

1San Francisco, CA United States

Keywords: glioblastoma multiforme, outcome, resection, recurrent disease, craniotomy

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     Extent of resection(EOR) has been shown to be an important prognostic factor for survival in patients undergoing initial surgery for glioblastoma(GBM), but the significance of EOR at repeat craniotomy for recurrence remains unclear.
     Medical records were reviewed for all patients undergoing craniotomy for GBM at our institution from 2005-2009. Patients who had a second craniotomy for pathologically confirmed recurrence following radiation and chemotherapy were evaluated.
     EOR was graded as gross-total(GTR) or subtotal(STR) after independent radiographic review. Overall survival was compared between groups using univariate and multivariate analysis.
     Multiple resections were performed in 108 patients. Fifty-two patients had initial GTR, of whom 32(62%) had GTR at recurrence with a median survival of 20.4±1.0 months, and 20(38%) had STR at recurrence with a survival of 18.3±0.5 months (difference not significant). Initial STR was performed in 56 patients, of whom 26(46%) had GTR at recurrence with a median survival of 19.0±1.2 months, and 30(54%) had STR with a survival of 14.7±1.6 months(p=0.002). A Cox proportional hazards model was constructed demonstrating that age, KPS, and EOR at repeat resection were independent predictors of survival(HR=0.57,p=0.01). EOR at initial resection was not a statistically significant factor(p=0.44) when repeat EOR was included in the model, suggesting that GTR at second craniotomy could overcome an initial STR.
     This is a retrospective study.
     EOR at recurrence is an important predictor of overall survival.
     If GTR is achieved at recurrence, overall survival is maximized regardless of initial EOR, suggesting that patients with primary STR should undergo repeat surgery with the goal of GTR at recurrence.


Project Roles:

O. Bloch (), S. Han (), G. Kaur (), M. Aghi (), M. McDermott (), M. Berger ()