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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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The role of surgery in the treatment of recurrent glioblastoma

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  • Andrej Pala - Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
  • Lea Schmitz - Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
  • Andreas Knoll - Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
  • Michal Hlavac - Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
  • Ralph König - Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
  • Christian Rainer Wirtz - Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
  • Jan Coburger - Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocP063

doi: 10.3205/18dgnc404, urn:nbn:de:0183-18dgnc4049

Published: June 18, 2018

© 2018 Pala et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Treatment decisions for recurrent glioblastoma (rGB) remain challenging. Individualized treatment options include surgery, various chemotherapeutic regimens and irradiation and are individually recommended by local multidisciplinary oncological teams. We have compared patients with rGB treated surgically or non-surgically and the impact of recurrent surgery on overall and progression free survival (OS, PFS).

Methods: The clinical and radiological data of 127 consecutive cases with rGB were evaluated retrospectively. We compared the surgically and the non-surgically treated patients’ cohorts. Kaplan Meier estimations of median PFS and OS were used. Multivariate Cox regression models including the major influencing variables (surgical resection, MGMT, Karnofsky performance scale, age, eloquent location) were calculated to analyze the survival benefit. Subgroup analysis of patients with MGMT positive and negative promotor methylation status was performed.

Results: Multiple Cox regression revealed inferior OS (p=0.029, OR=1.731, CI 95% 1.059-2.829) of patients without recurrent surgery(14 vs 31 months). Methylated MGMT and age were related to longer OS (p<0.001, OR 2.683, CI 95% 1.631-4.414 and p=0.009, OR=1.029, CI95% 1.007-.052 respectively). GTR in recurrent surgeries lead to median OS of 39 months vs 22 months and to PFS of 7 vs 4 months when compared to STR. Patients with unmethylated MGMT status and GTR survived significantly longer (31 months) than patients with unmethylated MGMT promotor and subtotal tumor resection (15 months, p=0.024, log rank). PFS were 6 vs. 4 months after GTR and STR respectively.

Conclusion: Recurrent GB surgery are safe procedures and might result in longer OS if compared to non-surgical treatment. Patients with non-methylated MGMT promoter might particularly benefit from GTR after recurrent surgery.