gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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The impact of resection on the treatment of glioblastoma multiforme: Survival comparison with the RTOG recursive partitioning analysis of ALA glioma study patients

Der Einfluss der Resektion bei Glioblastompatienten. Überlebensanalyse von Patienten der ALA Studie mit der RTOG rekursiven Partitions-Analyse

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  • corresponding author W. Stummer - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
  • G. Schackert - Neurochirurgische Klinik, Universitätsklinikum Carl Gustav Carus, Dresden
  • U. Pichlmeier - Medac Gesellschaft für klinische Spezialpräparate mbH, Wedel
  • ALA Gliom Studiengruppe

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.01.02

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc036.shtml

Published: May 30, 2008

© 2008 Stummer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The benefit of cytoreductive surgery for glioblastoma multiforme (GBM) has not been demonstrated conclusively and selection bias in past series has been demonstrated. The ALA study investigated the influence of fluorescence-guided resections on outcome, generating an extensive database on GBM patients with a high frequency of complete resections. With the present analysis we evaluated whether the RTOG recursive partitioning analysis (RPA) would predict survival of ALA study patients and whether there was any detectable benefit from extensive resections depending on RPA class.

Methods: Two hundred and fourty three per protocol patients with newly diagnosed GBM were operated either with or without ALA and treated by radiotherapy. Early postoperative MRI was obtained in all patients. Patients were allocated into RTOG-RPA classes III, IV and VI based on age, Karnofsky Performance Status, neurological condition and mental status (as derived from the National Institute of Health stroke score).

Results: Overall survival was different among RPA classes III, IV, and V, with median survival times of 17.8, 14.7 and 10.7 months, respectively, and 2-year survival rates of 26%, 12%, and 7%, respectively (P=0.0007). When stratified for complete vs. incomplete resections of contrast-enhancing tumor, survival for patients with complete resections was longer in RPA classes IV and V (17.7 vs. 12.9, p=0.0015, and 13.7 vs. 10.4, p=0.0398; 2-year rates: 21.0 vs. 4.4% and 11.1 vs. 2.6%, respectively). In the small subgroup of RPA class III patients, differences were 19.3 vs 16.3 months (p=0.14).

Conclusions: Survival of patients from the ALA study is correctly predicted by the RTOG-RPA classes. Differences in survival depending on resection status, especially in RPA classes IV and V, strongly support a causal influence of resection on survival.