Effect of surgical removal on survival and quality of life in patients with supratentorial glioblastoma.

The relationship between the extent of tumor resection and the progression-free survival, overall survival, and quality of life was evaluated retrospectively in 105 consecutive adult patients with supratentorial hemispheric glioblastoma not primarily involving the basal ganglia, thalamus, or hypothalamus. All patients underwent multidisciplinary treatment including tumor removal and postoperative adjuvant therapy in prospective randomized trials designed to test several chemotherapy regimens. Magnetic resonance imaging with contrast medium was used to determine the extent of tumor resection. Gross total resection (GTR) was performed in 35 patients (33%), partial resection (PR) in 57 (54%), and biopsy in 13 (12%). Univariate and multivariate analysis was performed to assess the prognostic relevance of the extent of resection. The Karnofsky performance status (KPS) improved from 78% to 83% in the GTR group. The difference was not statistically significant. There was no significant change in the PR (from 70% to 72%) and the biopsy groups (from 64% to 62%). Progression- free survival was significantly longer in the GTR group (median survival time [MST] 10.3 months) than in the PR (MST 5.2 months) and the biopsy groups (MST 3.6 months). The overall survival was significantly longer in the GTR group (MST 20 months) than in the PR (MST 14.2 months) and the biopsy groups (MST 8.3 months). The difference in survival between the PR and the biopsy groups was not statistically significant. GTR prolongs the survival of patients with glioblastoma compared to PR or biopsy.