Patients with recurrent glioblastoma who undergo multiple surgeries to remove tumors may survive longer than those who undergo only one surgery, according to the results of a study published in the Journal of Neurosurgery.
Glioblastoma mutiforme (GBM) is one of the most common and fatal types of primary brain cancer. It develops from the glial cells, which are the most abundant cells in the nervous system. Glial cells provide supportive functions that facilitate the work of neurons (cells that transmit impulses between the brain, spinal column, and nerves).
Treatment for GBM often involves surgery followed by radiation and chemotherapy. However, regardless of the intervention, GBM typically recurs and many patients will survive less than one year after diagnosis.
Because GBM is so prone to recurrence, there has been debate over the value of repeated surgeries. Each surgery carries inherent risks for additional neurological deficits and poor wound healing and as such, many physicians are reluctant to perform multiple surgeries in this population.
In order to evaluate whether patients who underwent repeated surgeries experienced improved survival, researchers conducted a retrospective analysis of data from 578 patients who underwent surgery to remove a glioblastoma between 1997 and 2007 at The Johns Hopkins Hospital. At the last follow-up, 354 patients had undergone one surgery, 168 had two surgeries, 41 had three surgeries, and 15 had four. The median survival improved with each additional surgery:
- One surgery was associated with a median survival of 6.8 months.
- Two surgeries were associated with a median survival of 15.5 months.
- Three surgeries were associated with a median survival of 22.4 months.
- Four surgeries were associated with a median survival of 26.6 months.
Patients who underwent only one surgery experienced shortened survival compared to those who underwent two, three, or four. The researchers concluded that patients with recurrent glioblastoma may experience improved survival with repeated surgeries—which not only reduce the size of tumors, but may also increase the efficacy of radiation and chemotherapy.
Repeated surgeries may not be appropriate for everyone and patients and physicians must weigh the potential risks against the potential benefits. The procedure should only be performed if patients can tolerate the anesthesia and long recovery period.
Chaichana KL, Zadnik P, Weingart JD, et al. Multiple resections for patients with glioblastoma: prolonging survival. Journal of Neurosurgery. Published early online October 19, 2012. DOI: 10.3171/2012.9.JNS1277.