Abstract
Despite updated management of glioblastoma (GB), progression is virtually inevitable. Previous data suggest a survival benefit from resection at progression; however, relatively few studies have evaluated the role of surgery in the context of contemporary GB treatment and widespread use of bevacizumab and chemotherapy. As such, the purpose of this study is to evaluate outcomes following surgical resection in patients with progressive GB since 2008. The records of all patients who underwent biopsy or resection of GB between January 1, 2008, and December 31, 2015, were retrospectively reviewed to identify 368 patients with progressive GB. Median survival and 95% confidence intervals were generated with the Kaplan-Meier method. Multivariate analysis, which controlled for age, Karnofsky Performance Status (KPS), extent of resection, adjuvant chemotherapy and radiation, tumor location, and tumor multifocality, of post-progression survival was carried out using a Cox proportional hazards model. Of 368 patients with progressive disease, 77 (20.9%) underwent resection at first documented progression. The median post-progression survivals for patients who did and did not undergo resection at this time were 12.8 and 7.0 months, respectively. In multivariate analysis, KPS ≥ 70 at progression (HR 0.438), receipt of bevacizumab at first progression (HR 0.756), and receipt of chemotherapy at first progression (HR 0.644) were associated with increased post-progression survival. Thus, surgery for progressive GB may not improve post-progression survival in the context of contemporary maximal non-surgical therapy. Further investigation is necessary to elucidate what role, if any, bevacizumab has in prolonging post-progression survival in patients with progressive GB.
Highlights
Glioblastoma (GB) is the most common primary malignancy of the central nervous system[1]
Two interventions are currently approved by the Food and Drug Administration (FDA) for progressive GB: bevacizumab, which is commonly used in the United States in this population, and delivery of low energy alternating electric fields via the Tumor Treating Fields
Chaichana et al previously concluded that resection for progressive GB and the number of resections were both associated with improved overall survival in a case-control analysis[9], the low overall survival of single-resection patients (6.8 months) and low proportion of patients receiving both radiation (65%) and temozolomide (27%) following initial surgery limit the relevance of results to the current era of GB treatment
Summary
Glioblastoma (GB) is the most common primary malignancy of the central nervous system[1]. Options for nearly inevitable disease progression include resection, systemic chemotherapy, radiation therapy, or clinical trial enrollment. Among these options, two interventions are currently approved by the Food and Drug Administration (FDA) for progressive GB: bevacizumab, which is commonly used in the United States in this population, and delivery of low energy alternating electric fields via the Tumor Treating Fields (Optune, Novocure Ltd, St. Helier, Jersey) device. Multivariate analysis, which controlled for age, Karnofsky Performance Status (KPS), extent of resection, adjuvant chemotherapy and radiation, tumor location, and tumor multifocality, of post-progression survival was carried out using a Cox proportional hazards model. The median post-progression survivals for patients who did and did not undergo resection at this time were 12.8 and 7.0 months, respectively. Further investigation is necessary to elucidate what role, if any, bevacizumab has in prolonging post-progression survival in patients with progressive GB
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