Abstract
BACKGROUND: While patients with high grade gliomas (HGG) experience a high rate of recurrence, current treatment at recurrence remains controversial. Historically, re-resection for recurrent GBM demonstrates a significant survival benefit following reoperation of 3-13 months compared to 1-2 months without treatment. Here we investigate whether re-resection will improve survival in patients receiving fractionated stereotactic radiotherapy (FSRT) for recurrence. METHODS: 231 patients with recurrent HGG treated with re-irradiation between 1994 and 2012 at our institution were analyzed. FSRT was delivered using daily fractions of 3.5 Gy, median total dose of 35 Gy. 105 patients also underwent re-resection. Survival was then analyzed comparing patients with and without re-resection. Median survival time (MST) was defined as survival from initial diagnosis. Survival time was analyzed using the Kaplan-Meier method. Univariate and multivariate analysis was performed. RESULTS: The MST for the entire group is 22.5 months. There is no significant difference in survival between patients who received re-resection vs no re-resection, the MST was 23 months, and 21.9 months respectively (HR 1.1, p = 0.6). Those undergoing re-resection, 30 received gross total resection and 75 subtotal resection, with a MST of 22.0 and 26 months, respectively (p = 0.24). On univariate analysis, age and histology were significant factors (P < 0.05). On multivariate analysis, age remained significant for survival but no other factor (chemotherapy, histology, extent of resection, eloquent location, KPS) was significant. CONCLUSIONS: Our data reveals there is no significant improvement in survival with the addition of re-resection to patients who received FSRT for recurrent HGG. To our knowledge, this data analyzes the largest cohort of HGG treated with FSRT with and without surgical resection after recurrence. We hypothesize that the favorable survival seen in our cohort is derived from local control benefit due to the addition of FSRT.
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