Article
A role for resective surgery in the treatment of multicentric/multifocal glioblastoma
Rolle der Tumorresektion in der Behandlung multizentrischer/multifokaler Glioblastome
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Published: | May 25, 2022 |
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Objective: The role of cytoreductive surgery in patients with multicentric/multifocal glioblastoma is controversial. For the present study we have investigated the role of resective surgery for multicentric/multifocal glioblastoma in a contemporary patient cohort.
Methods: Imaging data from all 434 cases with glioblastoma undergoing surgery in our department 2015-2020 were reviewed in order to identify cases with multicentric/multifocal growth. A multicentric/multifocal growth pattern was defined by the presence of ≥2 contrast enhancing lesions separated by ≥1 cm, and multicentric vs. multifocal growth as the presence vs. absence of a FLAIR hyperintense zone connecting the lesions. Pertinent clinical data were retrospectively collected and analyzed using standard statistical methods.
Results: We identified 73 patients with primary (IDH wildtype) glioblastoma with multicentric/multifocal growth. 38 (52.1%) had resections of the dominant lesion(s), and 31 (42.5%) a stereotactic and 4 (5.5%) an open biopsy. Specific growth patterns (i.e. multicentric, multifocal, bilateral, subarachnoid and subependymal spread; lesion number) were not prognostic. MGMT status, and mean age, preoperative KPI and NANO scores did not differ significantly between resection (age: 65±13 yrs.; MGMT methylated: 51.5%; KPI: 79±13; NANO score: 2.8±1.9) and biopsy cases (age: 69±13 yrs.; MGMT methylated: 40.0%; KPI: 75±18; NANO score: 2.9±2.7). Median survival differed significantly between resective and biopsy cases (10.1 vs. 3.4 months, P=0.008). A multivariate analysis with resection vs. biopsy, age, KPI, MGMT status, and adjuvant therapy (radiotherapy, chemotherapy, tumor treating fields) as covariates revealed only radiotherapy and chemotherapy as independent predictors of the patients’ prognosis. Postoperative KPI and NANO score changes did not vary with resection (mean KPI/ NANO score change: -2±14/ 0.3±2.0) vs. biopsy (mean KPI/ NANO score change: 0±6/ -0.1±1.3).
Conclusion: Our data suggest that resective vs. bioptic surgery in cases with multicentric/multifocal glioblastoma is safe and associated with a significant survival benefit. The multivariate analysis suggests that this finding may not necessarily reflect the impact of surgical cytoreduction. Rather, our data are in line with the view that resective surgery helps with the reduction of the mass effect of the tumor which is often required for effective adjuvant therapy.