gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Feasibility of surgery for recurrent glioblastoma: a retrospective single centre study

Meeting Abstract

  • S.M.A. Zella - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • M.E. El-Khatib - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • M. Wallocha - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • H.J. Steiger - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • M. Sabel - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.09.09

DOI: 10.3205/12dgnc087, URN: urn:nbn:de:0183-12dgnc0877

Published: June 4, 2012

© 2012 Zella 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: In contrast to the well defined role of cytoreductive surgery for primary Glioblastoma (GBM), the impact of surgery for recurrent GBM (rGBM) is still unclear. We have investigated the impact of open surgery for rGBM from the 1st to the 3rd recurrence on the extent of resection, Karnofsky Performance score (KPS) and progession free survival (PFS).

Methods: Inclusion criteria of database search were: histologically confirmed rGBM pretreated with open surgery followed by Stupp protocol. We identified 69 patients (median age: 61 years – range 22–75 years) treated at our Institution between January 2006 and June 2011. 69 patients were treated for the 1st recurrence, 30 patients for the 2nd and 12 patients for the 3rd recurrence with open surgery and subsequent adjuvant chemotherapy. For primary and consecutive surgery, extent of resection, KPS and PFS were determined.

Results: By the first operation a pre-operative tumor volume of 25.4 ccm was reduced to a post-operative tumor volume of 0.02 ccm, at 1st recurrence a preoperative tumor volume of 11.3 ccm was reduced to 0.04 ccm, at 2nd recurrence a preoperative tumor volume of 8.0 ccm was reduced to 0.5 ccm and at 3rd recurrence preoperative tumor volume of 7.9 ccm was reduced to 2.4 ccm (all median values). Median KPS did not decline after the first surgery (median pre-op KPS: 100%, median post-op KPS: 100%) and 1st re-operation (median pre-op KPS: 90%, median post-op KPS: 90%). After 2nd re-operation and 3rd re-operation KPS decreased from 80% to 70 % and from 70% to 60% respectively. Median PFS at first surgery was 9 months, at 1st re-operation 8 months, at 2nd re-operation 5 months and at 3rd re-operation 4 months.

Conclusions: Our study shows that, despite comparable resection rates, there is only a modest impact of surgery on KPS at 1st recurrence. On the other hand we observed a substantial decrease in KPS and in median PFS after operation for the 2nd and the 3rd recurrences. We recommend re-resection for 1st recurrence as a feasible treatment. Open surgery for 2nd and 3rd recurrence remains still problematic.