Abstract
BackgroundThere is currently limited evidence for surgery in recurrent glioblastoma (GBM). Our aim was to compare primary and recurrent surgeries, regarding changes in perioperative, generic health-related quality of life (HRQoL), complications, extents of resection and survival.MethodsBetween 2007 and 2018, 65 recurrent and 160 primary GBM resections were prospectively enrolled. HRQoL was recorded with EQ-5D 3L preoperatively and at 1 month postoperatively. Median perioperative change in HRQoL and change greater than the minimal clinically important difference (MCID) were assessed. Tumour volume and extent of resection were obtained from pre- and postoperative MRI scans. Survival was assessed from date of surgery.ResultsComparing recurrent surgeries and primary resections, most variables were balanced at baseline, but median age (59 vs. 62, p = 0.005) and median preoperative tumour volume (14.9 vs. 25.3 ml, p = 0.001) were lower in recurrent surgeries. There were no statistically significant differences regarding complication rates, neurological deficits, extents of resection or EQ-5D 3L index values at baseline and at follow-up. Twenty (36.4%) recurrent resections vs. 39 (27.5%) primary resections reported clinically significant deterioration in HRQoL at follow-up. Stratified by clinically significant change in EQ-5D 3L, the survival distributions were not statistically significantly different in either group. Survival was associated with extent of resection (p = 0.015) in recurrent surgeries only.ConclusionsOutcomes after primary and recurrent surgeries were quite similar in our practice. As surgery may prolong life in patients where gross total resection is obtainable with reasonable risk, the indication for surgery in GBM should perhaps not differ that much in primary and recurrent resections.
Highlights
Glioblastoma (GBM) is the most common primary malignant brain tumour in adults [24]
Olavs Hospital, recurrent surgery is often considered an option for patients who are functionally independent (e.g. Karnofsky performance status (KPS) ≥ 70), enhancing tumour volumes believed available for gross total resection, and when recurrence takes place at least six months after primary resections
We found that the risk of clinically significant perioperative deterioration in health-related quality of life (HRQoL), risk of neurological deficits, complications and extents of resection were rather comparable in primary and recurrent surgeries for GBM
Summary
Glioblastoma (GBM) is the most common primary malignant brain tumour in adults [24]. Due to the lack of evidence, there is no consensus on the best way to treat recurrent GBM. It is so far not settled whether reoperations for GBM prolong survival [9, 40]. There is currently limited evidence for surgery in recurrent glioblastoma (GBM). Our aim was to compare primary and recurrent surgeries, regarding changes in perioperative, generic health-related quality of life (HRQoL), complications, extents of resection and survival. Tumour volume and extent of resection were obtained from pre- and postoperative MRI scans.
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