Optimizing the management of glioblastoma per neurosurgical approach and therapeutic interventions on patient outcomes: A systematic review and meta-analysis

Abstract

This article presents a comprehensive systematic review and meta-analysis investigating the efficacy of diverse neurosurgical approaches and treatment modalities in addressing glioblastoma multiforme (GBM). The focus is on analyzing survival rates and prognostic implications of combined therapies, aiming to significantly improve patient prognosis and life expectancy. A thorough systematic review and meta-analysis of scientific literature concerning surgical outcomes and treatments for GBM patients was conducted. Extensive searches were performed using targeted keywords (i.e., glioblastoma, neurosurgical treatments, radiotherapy, and chemotherapy) across prominent databases such as ScienceDirect and PubMed, covering articles published until July 2023. Analysis of the scientific literature highlights the significance of partial or total resection, alongside biopsies and radiotherapy, in eradicating microscopic residues of GBM. In addition, the utilization of temozolomide (TZM) as a secondary approved agent in highly malignant tumors, coupled with the administration use of bevacizumab (BVZ) as a first-line treatment for GBM at any stage, demonstrates a substantial increase in patient survival rates. GBM remains a long-standing challenge in the medical field. Based on the type of resection (i.e., extensive total, partial, or subtotal), a treatment regimen involving a combination of chemotherapy, radiotherapy, biopsy, and suitable immunotherapy (such as Food and Drug Administration-approved agents such as TZM, lomustine, carmustine, or BVZ) is recommended. For postoperative GBM patients with communicating or obstructive hydrocephalus, the efficacy of a ventriculoperitoneal shunt in treating communicating hydrocephalus has been evidenced in studies.