Benefit of re-operation and salvage therapies for recurrent glioblastoma multiforme: results from a single institution
Benefit of re-operation and salvage therapies for recurrent glioblastoma multiforme: results from a single institution
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DOI：
10.1007/s11060-017-2383-2
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发表时间：
2017-05-01
影响因子：
3.9
通讯作者：
Abdulkarim, Bassam S.
中科院分区：
文献类型：
--
作者：
Azoulay, M.;Santos, F.;Abdulkarim, Bassam S.
复发性胶质母细胞瘤（GBM）的最佳管理尚未确定。我们的目的是评估复发性GBM的再手术和挽救治疗（化疗和/或再放疗）的益处，并确定与更好生存率相关的预后因素。本回顾性研究纳入了2005年1月至2012年12月期间接受GBM手术，随后接受辅助放疗，并在影像学上出现GBM复发的所有患者。使用考克斯模型进行单变量和多变量分析，以确定与总生存期（OS）相关的因素。接受60戈伊剂量治疗的180例患者被诊断为复发性GBM。中位随访时间为6.2个月，复发后的中位生存期（MS）为6.6个月。69例患者根据影像学检查接受了复发的再次手术。为了确定重复手术和挽救治疗的益处，将68例接受重复手术的患者与未接受重复手术的患者进行了匹配，这些患者基于初次切除的范围和复发时是否累及脑室下区。再次手术患者的MS为9.6个月，而未再次手术患者为5.3个月（p < 0.0001）。配对的多变量分析证实，重复手术加其他挽救治疗可显著影响患者结局（HR 0.53）。复发性GBM的再手术和额外的挽救治疗可延长进展时的生存期。
The optimal management of recurrent glioblastoma (GBM) has yet to be determined. We aim to assess the benefits of re-operation and salvage therapies (chemotherapy and/or re-irradiation) for recurrent GBM and to identify prognostic factors associated with better survival. All patients who underwent surgery for GBM between January 2005 and December 2012 followed by adjuvant radiotherapy, and who developed GBM recurrence on imaging were included in this retrospective study. Univariate and multivariate analysis was performed using Cox models in order to identify factors associated with overall survival (OS). One hundred and eighty patients treated to a dose of 60 Gy were diagnosed with recurrent GBM. At a median follow-up time of 6.2 months, the median survival (MS) from time of recurrence was 6.6 months. Sixty-nine patients underwent repeat surgery for recurrence based on imaging. To establish the benefits of repeat surgery and salvage therapies, 68 patients who underwent repeat surgery were matched to patients who did not based on extent of initial resection and presence of subventricular zone involvement at recurrence. MS for patients who underwent re-operation was 9.6 months, compared to 5.3 months for patients who did not have repeat surgery (p < 0.0001). Multivariate analysis in the matched pairs confirmed that repeat surgery with the addition of other salvage treatment can significantly affect patient outcome (HR 0.53). Re-operation with additional salvage therapies for recurrent GBM provides survival prolongation at the time of progression.