Survival after reoperation for recurrent glioblastoma. (March 2020)

• Record Type: Journal Article
• Authors: Woodroffe, Royce W.; Zanaty, Mario; Soni, Neetu; Mott, Sarah L.; Helland, Logan C.; Pasha, Arham; Maley, Joan; Dhungana, Neha; Jones, Karra A.; Monga, Varun; Greenlee, Jeremy D.W.
• Is Part Of: Journal of clinical neuroscience. Volume 73(2020)
• Page Start: 118
• Page End: 124
• Publication Date: 2020-03
• Subjects: Contrast enhancement -- MRI FLAIR signal change -- Progression free survival -- Overall survival; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.01.009
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: The volume of FLAIR signal hyperintensity on MRI was not found to be associated with prognosis. Volume of contrast enhancement prior to the initial surgery was associated with TTR and OS. Patients with involvement of critical/ eloquent areas had a poorer prognosis. Abstract: Determining which patients will benefit from reoperation for recurrent glioblastoma remains difficult and the impact of the volume of FLAIR signal hyperintensity is not well known. The primary purpose of this study is to analyze the impact of preoperative volume of FLAIR hyperintensity on prognosis. 37 patients who underwent a reoperation for recurrent glioblastoma after initial gross total resection followed by standard chemoradiation were retrospectively reviewed. Volumetric analysis of preoperative MR images from the initial and second surgery was performed and correlated with clinical data. Survival probabilities were estimated using the Kaplan-Meier method and Cox regression to assess the effect of risk factors on time to reoperation (TTR), progression-free survival (PFS) after reoperation, and overall survival (OS). The volumes of FLAIR signal hyperintensity prior to the initial surgery and reoperation were not associated with prognosis. TTR and OS were significantly affected by the preoperative enhancement volume at the initial surgery, with increasing volumes yielding poorer prognosis. Patients with tumor in critical/eloquent areas were found to have a worse prognosis. Median TTR was 11 months, median PFS after reoperation was 3 months, and OS in patients undergoing a reoperation was 21 months. The results suggest FLAIR signal change seen in patients with glioblastoma does not influence time to reoperation, progression-free survival, or overall survival. These findings suggest the amount of FLAIR signal change should not greatly influence a surgeon's decision to perform a second surgical resection compare to other factors, and when appropriate, aggressive surgical intervention should be considered.