Article
Recurrent glioblastoma multiforme: What is the role of local therapies, including repeated surgery and reirradiation? A systematic review of the literature and introduction of evidence-based guidelines
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Authors
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Lucas Serrano
- Neurochirurgische Klinik, Sana Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Deutschland
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Eleftherios Archavlis
- Neurochirurgische Klinik, Sana Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Deutschland
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Peter Ulrich
- Neurochirurgische Klinik, Sana Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Deutschland
| Published: | June 2, 2015 |
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Outline
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Objective: Recurrent glioblastomas are a challenging issue for treating physisians. Glioblastomas that are considered for repeated surgery can cause considerable morbidity and may pose a significant challenge during surgery. Reirradiation modalities such as brachytherapy and stereotactic radiosurgery are emerging treatments for high-grade gliomas in the recurrent situation. This study was undertaken to systematically review the evidence available for the role of local therapies and to make recommendations based on this evidence.
Method: A broad search strategy was used due to the relative small number of studies on this specific topic. PubMed (National Library of Medicine, http://www.ncbi.nlm.nih.gov) was searched using "ALL FIELDS" and entering "RECURRENT GLIOBLASTOMA" AND "SURGERY", "RADIOSURGERY", "RADIOTHERAPY", "REIRRADIATION" and "BRACHYTHERAPY" for a broad initial search. The results were then hand searched based on the titles and abstracts to exclude laboratory only studies and titles not on topic. We double-screened 1,781 abstracts and identified 85 eligible papers. Studies were extracted for participant information, intervention, survival outcomes, and adverse events, and they were individually and collectively assessed for methodological quality and strength of evidence.
Results: Evidence was generally of moderate quality. Repeat surgery is recommended in symptomatic patients with locally recurrent or progressive malignant glioma (Level II). The median survival in these patient diagnosed with glioblastoma is expected to range from 6 to 17 months following a second procedure. It is recommended that the following preoperative factors be considered when evaluating a patient for repeated operation: location of recurrence in eloquent/critical brain regions, Karnofsky Performance Status and tumor volume. Local salvage treatment with brachytherapy in case of inoperable recurrence and radiosurgery in case of small volume tumors is safe and may contribute to a prolonged survival in selected patients without significantly increasing morbidity or mortality (Level III).
Conclusions: Local therapies, including both repeated surgery and reirradiation add a survival advantage in selected patients without significantly increasing morbidity or mortality.
