Is there a role for reoperation in the management of glioblastoma?

Introduction: The standard treatment for Glioblastoma (GBM) is currently maximal safe surgical resection followed by radiation therapy and concomitant chemotherapy. Unfortunately, the disease will invariably recur even with the best treatment available; therapy goals must be to prolong survival at the best quality of life. Although literature suggests some advantage in reoperating patients harboring HGG, controversy still remain, specially regarding the most suitable candidates for reoperation.

Objective: We asked whether reoperation is an efficacious treatment strategy for GBM, and under which circumstances it can be indicated.

Methods: To address this issue, we retrospectively reviewed 286 consecutive cases of newly diagnosed GBM in a single University Hospital from 2008 to 2015. First, we evaluated clinical and epidemiological parameters possibly influencing overall survival (OS) by multivariate analysis. Second, overall survival from the diagnosis was calculated using the Kaplan-Meier method in patients submitted to one or two surgical procedures. Finally, the survival curves were fitted with the Weibull model, and survival at 12 and 24 months were estimated.

Results: Two or more surgeries were done after May 2009. The multivariate analysis revealed a positive correlation between survival and number of surgeries, initial KPS, and initial Ecog (all p < 0.001). The Kaplan-Meier curves differed consistently between groups submitted to one or more surgical procedures (p < 0.05, Wilcoxon). A mathematical regression for survival estimates was performed according to Weibull. Indeed, OS at 12 and 24 months was significantly greater for 2 surgeries. Resectability analysis according to RANO criteria were performed.

Conclusion: Our data indicate that reoperation for GBM is especially indicated for patients with good initial functional status (Ecog and KPS), and doubles survival estimates at 12 and 24 months.