Role of surgical resection in recurrent glioblastoma: prognostic factors and outcome evaluation in an observational study

The role of surgical resection in progressive or recurrent glioblastoma multiforme (GBM) lack of high level of evidence. The aim of this evaluation was to assess the role of surgical resection in relapsing GBM, in relation to the extent of surgical resection (EOR) and the amount of residual tumor volume (RTV). Among patients treated for newly diagnosed GBM between September 2008\u2013December 2014, 64 patients with recurrent GBM were included in this retrospective evaluation. All patients underwent surgical resection followed by adjuvant treatments, chemotherapy and/or radiotherapy Results were evaluated in terms of local control (LC) rate, progression free survival (PFS) and patients overall survival (OS). Gross total resection (GTR) (>90%) was achieved in 48 (75%) patients and subtotal resection (STR) in 16 (25%). RTV was 0 in 40 (62.5%) patients and >0 in 24 (37.5%). No severe postoperative morbidity occurred. The median LC time was 6.0 \ub1 0.1 months (95% CI 5.29\u20138.55), with a 1 and 2 years LC rate of 29.4 \ub1 6.9%. The median PFS time was 6.8 \ub1 0.8 months, with a 1\ua0year PFS rate of 27.2 \ub1 7.2% (95% CI 14.2\u201341.9). The median OS time was 10.3 \ub1 0.5 months (95% CI 7.6\u201310.4) with a 1 and 2 years OS rate of 22.5 \ub1 6.7% (95% CI 10.9\u201336.6). On univariate analysis EOR and RTV were recorded as conditioning LC and survival. These data was confirmed also in multivariate analysis only for RTV (p < 0.01). Recurrent GBM can take advantage of repeated surgery in selected patients with younger age and good clinical status. The entity of surgical resection was confirmed as conditioning survival

Hypofractionated stereotactic radiation therapy in recurrent high-grade glioma : a new challenge

Purpose The aim of this study was to evaluate outcomes of hypofractionated stereotactic radiation therapy (HSRT) in patients re-treated for recurrent high-grade glioma. Materials and Methods From January 2006 to September 2013, 25 patients were treated. Six patients underwent radiation therapy alone, while 19 underwent combined treatment with surgery and/or chemotherapy. Only patients with Karnofsky Performance Status (KPS) > 70 and time from previous radiotherapy greater than 6 months were re-irradiated. The mean recurrent tumor volume was 35 cm3 (range, 2.46 to 116.7 cm3), and most of the patients (84%) were treated with a total dose of 25 Gy in five fractions (range, 20 to 50 Gy in 5-10 fractions). Results The median follow-up was 18 months (range, 4 to 36 months). The progression-free survival (PFS) at 1 and 2 years was 72% and 34% and the overall survival (OS) 76% and 50%, respectively. No severe toxicity was recorded. In univariate and multivariate analysis extent of resection at diagnosis significantly influenced PFS and OS (p 50 cm3), respectively (p=0.26). Conclusion In our experience, HSRT could be a safe and feasible therapeutic option for recurrent high grade glioma even in patients with larger tumors. We believe that a multidisciplinary evaluation is mandatory to assure the best treatment for selected patients. Local treatment should also be considered as part of an integrated approach

Value of Surgical Resection in Patients with Newly Diagnosed Grade III Glioma Treated in a Multimodal Approach: Surgery, Chemotherapy and Radiotherapy

Background: Current treatments in grade III gliomas include surgery, radiotherapy, and chemotherapy. The value of the entity of surgical resection remains an open question. The aim of this evaluation was to analyze the impact of extent of resection (EOR) and residual tumor volume (RTV) on progression-free survival (PFS) and overall survival (OS) in patients with newly diagnosed grade III gliomas. Methods: Overall, 136 patients were included in this evaluation. EOR and RTV were defined in all patients on postoperative volumetric magnetic resonance imaging, with EOR being defined as the rate of surgical resection, and RTV as contrast-enhancing RTV (CE-RTV) and fluid-attenuated inversion recovery (FLAIR) RTV. A threshold of EOR and RTV was recorded using increments of 2\ua0% and 1\ua0cm3. Results: EOR and RTV were the only clinical variables influencing PFS and OS. The EOR cut-off value for conditioning survival was 76\ua0%. For EOR 6576\ua0% or 3\ua0cm3, 5- to 10-year PFS was 64.3\ua0% and 48.2\ua0% versus 42\ua0% and 0\ua0% (p\ua0=\ua00.02), and 5- to 10-year OS was 66.8\ua0% and 33.4\ua0% versus 56\ua0% and 0\ua0% (p\ua0=\ua00.3), respectively. RTV was a more significant parameter conditioning PFS and OS than EOR (p\ua0=\ua00.04), and the presence of CE-RTV was an unfavorable prognostic factor compared with FLAIR-RTV. Conclusions: In heterogeneous lesions from a radiological point of view as WHO grade III gliomas if a complete removal is not possible, it would be advisable to maximize the removal of enhancing areas, possibly with an EOR >76\ua0% and an RTV <3\ua0cm3

Outcome evaluation of patients with newly diagnosed anaplastic gliomas treated in a single institution

AIM: To evaluate the outcome of newly diagnosed anaplastic glioma patients treated in our institution in relation to the 2016 WHO classification suggestions. METHODS: This retrospective study included patients who underwent surgery plus adjuvant chemotherapy alone or concomitant and adjuvant chemoradiotherapy. Response was recorded using the Response Assessment in Neuro-Oncology criteria. RESULTS: 123 patients were analyzed. The median progression-free survival time and the 2, 3 and 5 years progression-free survival rate were 27 months, 65.5, 21.2 and 21.2%; the 2, 3 and 5 years overall survival rate were 89.7, 83.0 and 58.4%. From the univariate/multivariate analysis, the factors conditioning survival were Karnofsky performance scale, extent of resection, IDH1 mutation status and presence of 1p/19q codeletion. CONCLUSION: The choice of adjuvant treatment have to consider molecular assessment and, in our experience, the extent of surgical resection