Congress of neurological surgeons systematic review and evidence-based guidelines update on the role of cytoreductive surgery in the management of progressive glioblastoma in adults.

Hayes H Patrick,J Bradley Elder,Jonathan H Sherman,Jeffrey J Olson

doi:10.1007/s11060-021-03881-w

Abstract

In patients with previously diagnosed glioblastoma who are suspected of experiencing progression, does repeat cytoreductive surgery improve progression free survival or overall survival compared to alternative interventions? These recommendations apply to adults with previously diagnosed glioblastoma who are suspected of experiencing progression of the neoplastic process and are amenable to surgical resection. Level II: Repeat cytoreductive surgery is recommended in progressive glioblastoma patients to improve overall survival.

Highlights

RationalePrimary malignant brain tumors carry with them a dismal prognosis, and the most aggressive subtype of malignant gliomas, glioblastoma multiforme (GBM), is the most common [1]
In the previously published guideline a single question was asked: “Should patients with previously diagnosed malignant glioma who are suspected of experiencing progression of the neoplasm process undergo repeat open surgical resection?” A level II recommendation was formulated stating: “Repeat cytoreductive surgery is recommended in symptomatic patients with locally recurrent or progressive malignant glioma
It is recommended that the following preoperative factors be considered when evaluating a patient for repeat operation: location of recurrence in eloquent/critical brain regions, Karnofsky Performance Status and tumor volume.”

Summary

Introduction

Primary malignant brain tumors carry with them a dismal prognosis, and the most aggressive subtype of malignant gliomas, glioblastoma multiforme (GBM), is the most common [1]. Despite advances in diagnostic techniques, surgical interventions and medical treatments, long-term survival remains poor. Because of the poor survival outcomes associated with malignant glioblastoma, initial treatment strategies include an aggressive multimodal approach combining surgical resection, chemotherapy and radiation. Due to the malignant nature of these tumors, recurrence and progression of disease is extremely common. In order to prolong survival in these patients, treatment strategies at the time of recurrence have become more aggressive, with an increasing number of patients undergoing repeat operations in addition to salvage chemotherapy and adjuvant radiotherapy [2]. The role of repeat operation has been widely debated due to the relatively low amount of high-level data. Recommendations have supported the use of repeat operations in carefully selected patients

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