gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Residual enhancing disease after surgery for glioblastoma multiforme: National service evaluation of practice in the United Kingdom

Meeting Abstract

Search Medline for

  • Ruichong MA - Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Department of Neurosurgery, Oxford, United Kingdom
  • Aswin Chari - Imperial College Healthcare NHS Trust, Department of Neurosurgery, London, United Kingdom
  • Paul Brennan - Western General Hospital & University of Edinburgh, Centre for Clinical Brain Sciences, Department of Neurosurgery, Edinburgh, United Kingdom
  • British Neurosurgery Trainees Research Collaboration - London, United Kingdom
  • Colin Watts - Cambridge University Hospital NHS Foundation Trust, Addenbrooke’s Hospital, Department of Neurosurgery, Cambridge, United Kingdom

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.24.08

doi: 10.3205/17dgnc147, urn:nbn:de:0183-17dgnc1470

Published: June 9, 2017

© 2017 MA et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objectives: Despite extensive clinical research the prognosis for patients with glioblastoma (GBM) remains poor. Surgical management of GBM patients has improved significantly with the introduction of new technologies and clinical sub-specialisation. A growing body of clinical data highlights the prognostic importance of post-operative residual enhancing disease (RED) following resection. Recent clinical trial data has started to emphasise the importance of gross total resection (GTR), defined by the absence of RED on early post-operative MRI, compared to sub-total resection (STR). Here we report the results of a service evaluation of practice in the United Kingdom.

Methods: Multicentre prospective observation study to evaluate current neuro-oncological practice in the United Kingdom. Data was collected between 01/05/2016 and 31/07/2016 through the British Neurosurgery Trainees Research Collaborative. Patients were included if they had suspected GBM and were scheduled to undergo GTR at their first surgery. Inclusion criteria included adult patients (age >18) with suspected GBM on presenting magnetic resonance imaging (MRI) scan and multi-disciplinary meeting (MDT) decision that the tumour was suitable for GTR. Exclusion criteria included children (age <18) with subsequent histology that confirmed an alternative diagnosis.

Results: A total of 113 patients from 15 neurosurgical units who were deemed suitable for gross total resection for treatment of glioblastoma were recruited. There was varying use of surgical adjuncts between differing neurosurgical units. Most patients (70.8%) had a postoperative MRI scan within 72hours of surgery. GTR was deemed to be achieved at time of surgery in 82% (91/111) of cases, compared to only 45% (36/80) on postoperative MRI. RED was deemed operable in 16.3% (13/80) of cases, however, no patient underwent early repeat surgery for RED. The most commonly cited reason (38.5%, 5/13) was perceived lack of clinical benefit.

Conclusion: Despite advances in surgical technique there is a subset of patients in which GTR is thought possible, but not achieved at primary surgery. Thus residual disease may be amenable to early reintervantion. Further prospective surgical research is required to better define the prognostic implications of RED/GTR and explore the options for converting STR to GTR before starting definitive treatment.