BACKGROUND: This article discusses data from 3 randomized phase 3 trials, supporting a role for surgery in glioblastoma. METHODS: Data were reviewed by extent of resection during primary surgery from the ALA-Glioma Study (fluorescence-guided versus conventional resection), the BCNU wafer study (BCNU wafer versus placebo), and the EORTC Study 26981-22981 (radiotherapy versus chemoradiotherapy with temozolomide). RESULTS: For glioblastoma patients in the ALA study, median survival was 16.7 and 11.8 months for complete versus partial resection, respectively (P < 0.0001). Survival effects were maintained after correction for differences in age and tumor location. For glioblastoma patients who received ≥90% resection in the BCNU wafer study, median survival increased for BCNU wafer versus placebo (14.5 versus 12.4 months, respectively; P = 0.02), but no survival increase was found for <90% resection (11.7 versus 10.6 months, respectively; P = 0.98). In the EORTC study, absolute median gain in survival with chemoradiotherapy versus radiotherapy was greatest for complete resections (+4.1 months; P = 0.0001), compared with partial resections (+1.8 months; P = 0.0001), or biopsies (+1.5 months; P = 0.088), suggesting surgery enhanced adjuvant treatment. CONCLUSION: Complete resection appears to improve survival and may increase the efficacy of adjunct/adjuvant therapies. If safely achievable, complete resection should be the surgical goal for glioblastoma.
BACKGROUND: This article discusses data from 3 randomized phase 3 trials, supporting a role for surgery in glioblastoma. METHODS: Data were reviewed by extent of resection during primary surgery from the ALA-Glioma Study (fluorescence-guided versus conventional resection), the BCNU wafer study (BCNU wafer versus placebo), and the EORTC Study 26981-22981 (radiotherapy versus chemoradiotherapy with temozolomide). RESULTS: For glioblastomapatients in the ALA study, median survival was 16.7 and 11.8 months for complete versus partial resection, respectively (P < 0.0001). Survival effects were maintained after correction for differences in age and tumor location. For glioblastomapatients who received ≥90% resection in the BCNU wafer study, median survival increased for BCNU wafer versus placebo (14.5 versus 12.4 months, respectively; P = 0.02), but no survival increase was found for <90% resection (11.7 versus 10.6 months, respectively; P = 0.98). In the EORTC study, absolute median gain in survival with chemoradiotherapy versus radiotherapy was greatest for complete resections (+4.1 months; P = 0.0001), compared with partial resections (+1.8 months; P = 0.0001), or biopsies (+1.5 months; P = 0.088), suggesting surgery enhanced adjuvant treatment. CONCLUSION: Complete resection appears to improve survival and may increase the efficacy of adjunct/adjuvant therapies. If safely achievable, complete resection should be the surgical goal for glioblastoma.
Authors: J Capellades; P Teixidor; G Villalba; C Hostalot; G Plans; R Armengol; S Medrano; A Estival; R Luque; S Gonzalez; M Gil-Gil; S Villa; J Sepulveda; J J García-Mosquera; C Balana Journal: Clin Transl Oncol Date: 2016-12-22 Impact factor: 3.405
Authors: Robert Dubrow; Amy S Darefsky; Daniel I Jacobs; Lesley S Park; Michal G Rose; Maxwell S H Laurans; Joseph T King Journal: Neuro Oncol Date: 2013-09-17 Impact factor: 12.300
Authors: A Gutenberg; C B Lumenta; W E K Braunsdorf; M Sabel; H M Mehdorn; M Westphal; A Giese Journal: J Neurooncol Date: 2013-03-28 Impact factor: 4.130
Authors: Paolo Ferroli; Marco Schiariti; Gaetano Finocchiaro; Andrea Salmaggi; Melina Castiglione; Francesco Acerbi; Giovanni Tringali; Mariangela Farinotti; Morgan Broggi; Cordella Roberto; Elio Maccagnano; Giovanni Broggi Journal: Neurol Sci Date: 2013-03-12 Impact factor: 3.307