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

The role of resection on survival times in recurrent high grade glioma

Meeting Abstract

  • Marco Skardelly - Tübingen, Deutschland
  • Felix Behling - Eberhard-Karls Universität Tübingen, Universitätsklinik Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Susan Noel - Tübingen, Deutschland
  • Jens Schittenhelm - Universitätsklinik Tübingen, Institut für Neuropathologie, Tübingen, Deutschland
  • Benjamin Bender - Tübingen, Deutschland
  • Ghazaleh Tabatabai - Universitätsklinikum Tübingen, Klinik für Neurologie, Interdisziplinäre Sektion Neuroonkologie, Tübingen, Deutschland
  • Marcos Tatagiba - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland

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. DocMi.22.09

doi: 10.3205/17dgnc520, urn:nbn:de:0183-17dgnc5204

Published: June 9, 2017

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



Objective: In newly diagnosed high-grade glioma (HGG) the role of resection is well explored. The median overall survival correlates with the extent of resection. In contrast, in recurrent HGG the role of recurrent resection is unresolved, so far. Only a few retrospective studies suggest a potential benefit for overall survival (OS) or post-progression survival (PPS) after resection but convincing evidence is still missing. We investigated the effect resection in the treatment of recurrent HGG on OS and PPS accounting for potential confounders.

Methods: We enclosed 331 patients >18 years of age who received treatment for first recurrent HGG in our clinic between 2006 and 2014 in a retrospective single cohort study. Clinical parameters included age, histology, methylation of O6-methylguanine-DNA methyltransferase (MGMT), mutations of isocitrate dehydrogenase, extent of resection, tumor location, eloquence, Karnofsky performance status (KPS) and adjuvant therapy. Survival times were determined by Kaplan Meier analyses. After univariate regressions of potential covariates of survival times, all univariate significant predictors were included in multivariate analyses of OS and PPS for HGG and for the subgroup of glioblastoma (GBM).

Results: A total of 260/331 patients were eligible for Kaplan-Meier analyses and Cox regressions in HGG and 214/271 in GBM. Median PPS times in HGG were 12 months (95% CI 10-17) for patients with gross total resection (n=171), 8 months (95% CI 2-21) for subtotal resection (n=70) and 8 months (95% CI 7-9) for no resection or biopsy (n=19). In the subgroup of GBM, median OS times were 11 months (95% CI 8-15) for patients with gross total resection (n=148), 6 months (95% CI 2-10) for subtotal resection (n=53) and 8 months (95% CI 7-9) for no resection or biopsy (n=13). Multivariate Cox regression of PPS and OS were adjusted for age, KPS, MGMT status, prognostic group, therapy groups, relation to ventricle and location of the tumor. Cox regressions did not show a significant PPS benefit for patients with subtotal (RR 1.12; 95% CI 0.62-1.88; p=0.69) or gross total resection (RR 0.77; 95% CI 0.54-1.07; p=0.12) in HGG and also no survival benefit for patients with subtotal (RR 1.27; 95% CI 0.67-2.23; p=0.44) or gross total resection (RR 0.82; 95% CI 0.56-1.18; p=0.28) with GBM. Kaplan Meier and Cox regression for OS times showed the same findings.

Conclusion: Out data do not suggest a recommendation for re-resection in recurrent HGG in general.