Efficacy of surgery and further treatment of progressive glioblastoma

BACKGROUND Treatment options for patients with glioblastoma at progression have remained controversial and selection criteria for the appropriate type of intervention remain poorly defined. The objectives were to determine which factors favor the decision for second surgery and which factors are associated with overall survival (OS) and to evaluate the NIH recurrent glioblastoma scale. The scale includes tumor involvement of eloquent brain regions, functional status and tumor volume. METHODS A retrospective single center analysis of patients with newly diagnosed glioblastoma undergoing initial surgery between January 2007 and December 2011 was performed. Patients were separated into two groups: those with vs. those without second resection surgery at disease progression. OS was compared using the multiple logistic regression model, Cox proportional hazard regression, and Kaplan-Meier survival analysis. RESULTS The data of 98 patients was statistically analyzed. 58 patients had initial surgery only (age 61.27y; mOS 14.81 months), 40 patients underwent second surgery at disease progression (age 55y; mOS 18.86 months). Age was the only predictor for repeated surgery (P 0.012; odds ratio 0.94. At the time of tumor progression, administration of alkylating chemotherapy (P 0.004; HR 0.24) or bevacizumab (P 0.001; HR 0.23) was associated with longer OS. Reoperation was associated with a lower hazard ratio (P 0.134; HR 0.66). The NIH recurrent glioblastoma scale showed statistically significant improvement of prognosis prediction with the addition of age. CONCLUSIONS Surgery of progressive glioblastoma and postoperative treatment at the time of progression is associated with improved OS in some patients. The addition of age may improve survival prediction of the NIH recurrent glioblastoma scale