Suchorska Bogdana, Weller Michael, Tabatabai Ghazaleh, Senft Christian, Hau Peter, Sabel Michael C, Herrlinger Ulrich, Ketter Ralf, Schlegel Uwe, Marosi Christine, Reifenberger Guido, Wick Wolfgang, Tonn Jörg C, Wirsching Hans-Georg
Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.).
Neuro Oncol. 2016 Apr;18(4):549-56. doi: 10.1093/neuonc/nov326. Epub 2016 Jan 27.
The role of reoperation for recurrent glioblastoma (GBM) remains unclear. Prospective studies are lacking. Here, we studied the association of clinical outcome with extent of resection upon surgery for recurrent GBM in the patient cohort of DIRECTOR, a prospective randomized multicenter trial comparing 2 dose-intensified temozolomide regimens at recurrence of GBM.
We analyzed prospectively collected clinical and imaging data from the DIRECTOR cohort (N = 105). Volumetric analysis was performed on gadolinium contrast-enhanced MRI as well as fluid attenuated inversion recovery/T2 MRI and correlated with PFS after initial progression (PFS2) and post-recurrence survival (PRS). Quality of life was monitored by the EORTC QLQ-C30 and QLQ-BN20 questionnaires at 8-week intervals.
Seventy-one patients received surgery at first recurrence. Prognostic factors, including age, MGMT promoter methylation, and Karnofsky performance score, were balanced between patients with and without reoperation. Outcome in patients with versus without surgery at recurrence was similar for PFS2 (2.0 mo vs 1.9 mo, P = .360) and PRS (11.4 mo vs 9.8 mo, P = .633). Among reoperated patients, post-surgery imaging was available in 59 cases. In these patients, complete resection of contrast-enhancing tumor (N = 40) versus residual detection of contrast enhancement (N = 19) was associated with improved PRS (12.9 mo [95% CI: 11.5-18.2] vs 6.5 mo [95% CI: 3.6-9.9], P < .001) and better quality of life. Incomplete tumor resection was associated with inferior PRS compared with patients who did not undergo surgery (6.5 vs 9.8 mo, P = .052). Quality of life was similar in these 2 groups.
Surgery at first recurrence of GBM improves outcome if complete resection of contrast-enhancing tumor is achieved.
复发性胶质母细胞瘤（GBM）再次手术的作用仍不明确。缺乏前瞻性研究。在此，我们在DIRECTOR患者队列中研究了复发性GBM手术切除范围与临床结局的关联，DIRECTOR是一项前瞻性随机多中心试验，比较GBM复发时两种剂量强化替莫唑胺方案。
我们分析了DIRECTOR队列（N = 105）中前瞻性收集的临床和影像数据。对钆增强MRI以及液体衰减反转恢复/T2 MRI进行容积分析，并与初始进展后的无进展生存期（PFS2）和复发后生存期（PRS）相关联。通过欧洲癌症研究与治疗组织QLQ-C30和QLQ-BN20问卷每8周监测一次生活质量。
71例患者在首次复发时接受了手术。包括年龄、MGMT启动子甲基化和卡诺夫斯基性能评分在内的预后因素在接受和未接受再次手术的患者之间是平衡的。复发时接受手术和未接受手术的患者在PFS2（2.0个月对1.9个月，P = 0.360）和PRS（11.4个月对9.8个月，P = 0.633）方面结局相似。在接受再次手术的患者中，59例有术后影像资料。在这些患者中，对比增强肿瘤完全切除（N = 40）与对比增强残留（N = 19）相比，PRS改善（12.9个月[95%CI：11.5 - 18.2]对6.5个月[95%CI：3.6 - 9.9]，P < 0.001）且生活质量更好。与未接受手术的患者相比，肿瘤切除不完全与较差的PRS相关（6.5对9.8个月，P = 0.052）。这两组的生活质量相似。
如果实现对比增强肿瘤的完全切除，GBM首次复发时手术可改善结局。
