Bogdana Suchorska1, Michael Weller1, Ghazaleh Tabatabai1, Christian Senft1, Peter Hau1, Michael C Sabel1, Ulrich Herrlinger1, Ralf Ketter1, Uwe Schlegel1, Christine Marosi1, Guido Reifenberger1, Wolfgang Wick1, Jörg C Tonn1, Hans-Georg Wirsching1. 1. Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.).
Abstract
BACKGROUND: The role of reoperation for recurrent glioblastoma (GBM) remains unclear. Prospective studies are lacking. Here, we studied the association of clinical outcome with extent of resection upon surgery for recurrent GBM in the patient cohort of DIRECTOR, a prospective randomized multicenter trial comparing 2 dose-intensified temozolomide regimens at recurrence of GBM. METHODS: We analyzed prospectively collected clinical and imaging data from the DIRECTOR cohort (N = 105). Volumetric analysis was performed on gadolinium contrast-enhanced MRI as well as fluid attenuated inversion recovery/T2 MRI and correlated with PFS after initial progression (PFS2) and post-recurrence survival (PRS). Quality of life was monitored by the EORTC QLQ-C30 and QLQ-BN20 questionnaires at 8-week intervals. RESULTS: Seventy-one patients received surgery at first recurrence. Prognostic factors, including age, MGMT promoter methylation, and Karnofsky performance score, were balanced between patients with and without reoperation. Outcome in patients with versus without surgery at recurrence was similar for PFS2 (2.0 mo vs 1.9 mo, P = .360) and PRS (11.4 mo vs 9.8 mo, P = .633). Among reoperated patients, post-surgery imaging was available in 59 cases. In these patients, complete resection of contrast-enhancing tumor (N = 40) versus residual detection of contrast enhancement (N = 19) was associated with improved PRS (12.9 mo [95% CI: 11.5-18.2] vs 6.5 mo [95% CI: 3.6-9.9], P < .001) and better quality of life. Incomplete tumor resection was associated with inferior PRS compared with patients who did not undergo surgery (6.5 vs 9.8 mo, P = .052). Quality of life was similar in these 2 groups. CONCLUSION: Surgery at first recurrence of GBM improves outcome if complete resection of contrast-enhancing tumor is achieved.
RCT Entities:
BACKGROUND: The role of reoperation for recurrent glioblastoma (GBM) remains unclear. Prospective studies are lacking. Here, we studied the association of clinical outcome with extent of resection upon surgery for recurrent GBM in the patient cohort of DIRECTOR, a prospective randomized multicenter trial comparing 2 dose-intensified temozolomide regimens at recurrence of GBM. METHODS: We analyzed prospectively collected clinical and imaging data from the DIRECTOR cohort (N = 105). Volumetric analysis was performed on gadolinium contrast-enhanced MRI as well as fluid attenuated inversion recovery/T2 MRI and correlated with PFS after initial progression (PFS2) and post-recurrence survival (PRS). Quality of life was monitored by the EORTC QLQ-C30 and QLQ-BN20 questionnaires at 8-week intervals. RESULTS: Seventy-one patients received surgery at first recurrence. Prognostic factors, including age, MGMT promoter methylation, and Karnofsky performance score, were balanced between patients with and without reoperation. Outcome in patients with versus without surgery at recurrence was similar for PFS2 (2.0 mo vs 1.9 mo, P = .360) and PRS (11.4 mo vs 9.8 mo, P = .633). Among reoperated patients, post-surgery imaging was available in 59 cases. In these patients, complete resection of contrast-enhancing tumor (N = 40) versus residual detection of contrast enhancement (N = 19) was associated with improved PRS (12.9 mo [95% CI: 11.5-18.2] vs 6.5 mo [95% CI: 3.6-9.9], P < .001) and better quality of life. Incomplete tumor resection was associated with inferior PRS compared with patients who did not undergo surgery (6.5 vs 9.8 mo, P = .052). Quality of life was similar in these 2 groups. CONCLUSION: Surgery at first recurrence of GBM improves outcome if complete resection of contrast-enhancing tumor is achieved.
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