gms | German Medical Science

Objective: In contrast to the well defined role of cytoreductive surgery for primary Glioblastoma (GBM), the impact of surgery for recurrent GBM (rGBM) is still unclear. We have investigated the impact of open surgery for rGBM from the 1^st to the 3^rd recurrence on the extent of resection, Karnofsky Performance score (KPS) and progession free survival (PFS).

Methods: Inclusion criteria of database search were: histologically confirmed rGBM pretreated with open surgery followed by Stupp protocol. We identified 69 patients (median age: 61 years – range 22–75 years) treated at our Institution between January 2006 and June 2011. 69 patients were treated for the 1^st recurrence, 30 patients for the 2^nd and 12 patients for the 3^rd recurrence with open surgery and subsequent adjuvant chemotherapy. For primary and consecutive surgery, extent of resection, KPS and PFS were determined.

Results: By the first operation a pre-operative tumor volume of 25.4 ccm was reduced to a post-operative tumor volume of 0.02 ccm, at 1^st recurrence a preoperative tumor volume of 11.3 ccm was reduced to 0.04 ccm, at 2^nd recurrence a preoperative tumor volume of 8.0 ccm was reduced to 0.5 ccm and at 3^rd recurrence preoperative tumor volume of 7.9 ccm was reduced to 2.4 ccm (all median values). Median KPS did not decline after the first surgery (median pre-op KPS: 100%, median post-op KPS: 100%) and 1^st re-operation (median pre-op KPS: 90%, median post-op KPS: 90%). After 2^nd re-operation and 3^rd re-operation KPS decreased from 80% to 70 % and from 70% to 60% respectively. Median PFS at first surgery was 9 months, at 1^st re-operation 8 months, at 2^nd re-operation 5 months and at 3^rd re-operation 4 months.

Conclusions: Our study shows that, despite comparable resection rates, there is only a modest impact of surgery on KPS at 1^st recurrence. On the other hand we observed a substantial decrease in KPS and in median PFS after operation for the 2^nd and the 3^rd recurrences. We recommend re-resection for 1^st recurrence as a feasible treatment. Open surgery for 2^nd and 3^rd recurrence remains still problematic.