Recurrent glioblastoma: consider after effects before choosing palliative surgery
medwireNews: Before suggesting surgery as palliative therapy for patients with recurrent glioblastoma, physicians should consider the impact of morbidities on quality of life, suggest researchers from Italy.
Their study results show that overall survival rates for glioblastoma patients who undergo tumor resection as a result of recurring disease are similar to those for their peers who receive no active treatment, but best supportive care.
The team also reports that clinical status at the time of glioblastoma recurrence, measured on the Karnofsky performance scale (KPS), is the most important indicator of survival, with higher scores indicating longer survival.
"Our findings could provide useful information for clinical management of these patients, whose treatment is somewhat frustrating," say Pasquale De Bonis and colleagues, from the Catholic University School of medicine in Rome, in Clinical Neurology and Neurosurgery.
The team treated 76 patients with recurrent glioblastoma between January 2002 and June 2008; 17 with surgery alone, 24 with adjuvant therapy (chemotherapy) alone, 16 with surgery and adjuvant therapy, and 19 patients with supportive care (corticosteroids and anticonvulsant agents).
The median overall survival was 7 months, compared with 6 months in the surgery-alone group and 5 months in the supportive care group. Chemotherapy-only-treated patients had a median overall survival of 8 months, and those treated with surgery and chemotherapy survived for a median of 14 months.
Univariate analysis indicated that KPS was significantly associated with survival, and this was confirmed in regression analysis, which showed that patients with a KPS less than 70 had a significant 2.8-fold increased risk for death compared with those whose KPS was above this score.
De Bonis and team observed no survival differences between patients who received gross total (n=11) or partial (n=22) tumor resection, suggesting that "a more aggressive surgical resection is not justified," they comment.
Almost half (48%) of patients experienced a major surgical morbidity; a major motor deficit in four patients, an altered consciousness and severe disability in three, wound dehiscence/subgaleal collection/hydrocephalus needing further hospitalization and surgical treatment in eight, and one patient death.
Rates of surgical morbidity did also not differ significantly according to the extent of surgery (gross total vs partial).
"When faced with evidence of recurrent GBM [glioblastoma], surgical intervention requires clear identification of short-term goals and a diligent consideration of overall prognosis, including potential treatment side effects," conclude De Bonis et al.
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