BACKGROUND: The management and prognosis of glioblastoma patients after Stupp protocol treatment and progression during bevacizumab (BV) treatment remain undefined. OBJECTIVE: We compared the morbidity and survival of patients whose glioblastomas progressed during BV treatment requiring craniotomy with those of patients not treated with BV. METHODS: We retrospectively reviewed patients who underwent craniotomy for recurrent glioblastoma from 2005 to 2009. Patients operated on for progression during BV (preoperative BV) were compared with patients receiving no BV or receiving BV after surgery (postoperative BV). Patients receiving BV preoperatively were compared with those patients whose gliobastoma progressed on BV treatment but were not operated on (no surgery). RESULTS: There were 23 preoperative BV patients, 135 no BV patients, 16 postoperative BV patients, and 25 no surgery patients. Patients receiving BV preoperatively had a worse postoperative overall survival rate (hazard ratio, 3.1; P < .001) and worse postoperative progression-free survival rate (hazard ratio, 3.4, P < .001) than patients not receiving BV. Patients receiving BV preoperatively had a higher perioperative morbidity rate (44%) than patients not receiving preoperative BV (21%) (P = 0.02). Survival after diagnosis was comparable between groups (86-93 weeks, P = .9), consistent with glioblastomas developing BV evasion being not intrinsically more aggressive, but possibly BV evasion conferring a uniquely poor prognosis. No surgery patients had a shorter overall survival after progression during BV treatment compared with preoperative BV patients (hazard ratio, 3.6, P < .001). CONCLUSION: Patients whose glioblastomas progress while receiving BV leading to craniotomy exhibit shorter postoperative survival and more perioperative morbidity than patients not treated with BV. Although there may be benefits to surgical debulking, the decision to pursue repeat surgery in patients in whom BV treatment failed must be balanced against the increased risk of perioperative complications.
BACKGROUND: The management and prognosis of glioblastomapatients after Stupp protocol treatment and progression during bevacizumab (BV) treatment remain undefined. OBJECTIVE: We compared the morbidity and survival of patients whose glioblastomas progressed during BV treatment requiring craniotomy with those of patients not treated with BV. METHODS: We retrospectively reviewed patients who underwent craniotomy for recurrent glioblastoma from 2005 to 2009. Patients operated on for progression during BV (preoperative BV) were compared with patients receiving no BV or receiving BV after surgery (postoperative BV). Patients receiving BV preoperatively were compared with those patients whose gliobastoma progressed on BV treatment but were not operated on (no surgery). RESULTS: There were 23 preoperative BVpatients, 135 no BVpatients, 16 postoperative BVpatients, and 25 no surgery patients. Patients receiving BV preoperatively had a worse postoperative overall survival rate (hazard ratio, 3.1; P < .001) and worse postoperative progression-free survival rate (hazard ratio, 3.4, P < .001) than patients not receiving BV. Patients receiving BV preoperatively had a higher perioperative morbidity rate (44%) than patients not receiving preoperative BV (21%) (P = 0.02). Survival after diagnosis was comparable between groups (86-93 weeks, P = .9), consistent with glioblastomas developing BV evasion being not intrinsically more aggressive, but possibly BV evasion conferring a uniquely poor prognosis. No surgery patients had a shorter overall survival after progression during BV treatment compared with preoperative BVpatients (hazard ratio, 3.6, P < .001). CONCLUSION:Patients whose glioblastomas progress while receiving BV leading to craniotomy exhibit shorter postoperative survival and more perioperative morbidity than patients not treated with BV. Although there may be benefits to surgical debulking, the decision to pursue repeat surgery in patients in whom BV treatment failed must be balanced against the increased risk of perioperative complications.
Authors: Yu-Long Hu; Michael DeLay; Arman Jahangiri; Annette M Molinaro; Samuel D Rose; W Shawn Carbonell; Manish K Aghi Journal: Cancer Res Date: 2012-03-23 Impact factor: 12.701
Authors: Michael DeLay; Arman Jahangiri; W Shawn Carbonell; Yu-Long Hu; Sean Tsao; Maxwell Wing Tom; Jesse Paquette; Taku A Tokuyasu; Manish K Aghi Journal: Clin Cancer Res Date: 2012-04-03 Impact factor: 12.531
Authors: Cecilia L Dalle Ore; Ankush Chandra; Jonathan Rick; Darryl Lau; Maryam Shahin; Alan T Nguyen; Michael McDermott; Mitchel S Berger; Manish K Aghi Journal: Neurosurgery Date: 2019-12-01 Impact factor: 4.654
Authors: Ruby Kuang; Arman Jahangiri; Smita Mascharak; Alan Nguyen; Ankush Chandra; Patrick M Flanigan; Garima Yagnik; Jeffrey R Wagner; Michael De Lay; Diego Carrera; Brandyn A Castro; Josie Hayes; Maxim Sidorov; Jose Luiz Izquierdo Garcia; Pia Eriksson; Sabrina Ronen; Joanna Phillips; Annette Molinaro; Suneil Koliwad; Manish K Aghi Journal: JCI Insight Date: 2017-01-26