Surgery for glioma relapse. Factors that influence a favorable outcome.

The role of cytoreductive surgery alone as effective salvage therapy for immediate palliation and durable symptom-free remission was examined in 17 patients (six with astrocytoma, seven with anaplastic astrocytoma, and four with glioblastoma) who developed symptomatic tumor relapse after initial surgery and irradiation. Individuals with widely disseminated subependymal, bihemispheral, or brainstem involvement were excluded. After reoperation, patients with astrocytoma and anaplastic tumors have been observed for an average of 31 and 29 months, respectively. As of this writing, all 13 patients are alive without evidence of tumor progression. Three of the four patients with glioblastomas have died 5, 12, and 17 months after reoperation, respectively. The 14 surviving patients overall have a current average Karnofsky performance level of 95. The durability of surgically induced palliation alone, the safe limits of resectability, and the clinical features associated with a favorable surgical response have been examined. The results indicate that, in selected individuals, durable remissions can be achieved by adequate resection of symptomatic tumor mass.