The Role and Real Impact of an Iterative Surgical Approach for the Management of Recurrent High Grade Glioma: an Observational Analytic Cohort study.

The Role and Real Impact of an Iterative Surgical Approach for the Management of Recurrent High Grade Glioma: an Observational Analytic Cohort study.

World Neurosurg. 2019 Jan 02;:

Authors: Salvati M, Pesce A, Palmieri M, Brunetto F, Santoro A, Frati A

Abstract
BACKGROUND: The benefits of multiple interventions on recurrences of High Grade Gliomas are renowned, the real impact of re-operation on survival parameters appears to be not overall assessed yet. The aim of this study is to show that proposing re-operation to selected patients is safe and feasible.
MATERIALS AND METHODS: 78 patients affected by High Grade Gliomas have been operated between 2004 and 2014. All patient respected the following inclusion criteria: ASA score=1-3, KPS>60 and re-intervention after at least 4 months after the first surgical procedure. The following parameters have been evaluated: Overall Survival after diagnosis and after re-intervention, Progression Free Survival after re-intervention, number of surgical procedures, Overall Survival in patients operated on more than 2 times. The results have been compared to 78 cases of High Grade Gliomas treated with adjuvant chemotherapeutic protocols.
RESULTS: Overall survival at 1 year resulted of 100%, at 2 years we registered 39.4% in case of Glioblastoma and 58.3% for Anaplastyc Astrocitoma. Progression free survival after 6 months resulted of 53.03% in case of Glioblastoma and 75.0% for Anaplastic Astrocytoma. 55 patients have been re-operated on, 15 underwent a third intervention and 8 received four surgical procedure. Major complications were registered in only 2 cases. The statistical analysis ruled out significant differences between in terms of complication and worsening of the neurological status.
CONCLUSIONS: The data show excellent outcomes in terms of survival and clinical conditions after multiple surgical procedures. Therefore, re-intervention appears to be a feasible and safe solution in selected patients.

PMID: 30610982 [PubMed - as supplied by publisher]

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