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57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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In case of reoperation of a malignant glioma pure radiation necrosis is a rarity

Reine Strahlennekrose bei Reoperationen maligner Gliome ist eine Seltenheit.

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  • corresponding author J.A. Seidel - Neurochirurgische Abteilung der Universität Ulm
  • K. Seitz - Neurochirurgische Abteilung der Universität Ulm
  • H.-P. Richter - Neurochirurgische Abteilung der Universität Ulm

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 08.103

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc320.shtml

Published: May 8, 2006

© 2006 Seidel 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: Malignant cerebral gliomas have a high risk for recurrent tumour growth. In case of suspicion of a tumour recurrence after malignant cerebral glioma a wait-and-see behaviour is often observed because regrowth and radiation necrosis are difficult to distinguish. Positrone emission tomography helps to differentiate tumour recurrence from radiation necrosis.

Methods: Between March 2000 and May 2005, we operated on 40 patients with suspected tumour recurrence. All Patients had had at least one previous surgery for a cerebral tumour (anaplastic astrocytoma/oligodendroglioma WHO III or glioblastoma). All patients had received adjuvant radiotherapy before reoperation. Adjuvant chemotherapy had been performed in 23 patients.

Results: Intraoperative tissue samples from all 40 patients were examined histopathologically and patients could be divided into five groups as follows: Pure tumour tissue (14 patients), mixture of recurrent tumour and radiation necrosis (16), extensive radiation necrosis and isolated tumour cells (7), pure radiation necrosis (2) and normal brain tissue (1).

Two patients had to be excluded from the follow-up (at least 12 months) because they were just re-operated. Patients with pure tumour tissue (group 1) showed in 79% (11/14) a definite recurrence, patients with a mixture of recurrent tumour and radiation necrosis (group 2) in 81% (13/16) and patients with extensive radiation necrosis and isolated tumour cells (group 3) in 80% (4/5). So there is no difference in probability of a new tumour growth among these three groups. And also two of those three cases where no tumour cells were discovered later on showed a tumour growth. 11C-Methionine PET was performed in 8 cases before reoperation. In seven patients the suspected formation showed an uptake highly suspicious of tumour tissue.

Conclusions: In our experience in case of reoperation of a malignant glioma pure radiation necrosis is a rarity. Mostly, at least some tumour cells are detected. For that reason in every suspicion of recurrence the wait-and-see behaviour is questionable. Whenever tumour recurrence is assumed, we recommend an early reoperation if indicated and chemotherapy in all cases.