'Recurrent' glioblastoma multiforme, when should we reoperate?

The surgical management of recurrent glioblastoma multiforme is controversial. Recent publications suggest that re-operation provides 3-5 months median survival, without significant increases in morbidity or mortality. Age (< or =50 years, although older patients may also benefit) and performance status (Karnofsky performance score > or =60-70) are the most important factors. Re-resection not only improves symptoms and maintains quality of life, it can delay symptom progression, reduce corticosteroid doses, and also improve response to (and allow intra-operative) chemotherapy and/or radiotherapy. Surgical treatment of recurrent glioblastoma multiforme in selected patients should always be considered.