Azoulay M, Santos F, Shenouda G, Petrecca K, Oweida A, Guiot M C, Owen S, Panet-Raymond V, Souhami L, Abdulkarim Bassam S
Department of Oncology, Division of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, 1001 Decarie Boulevard, Montréal, QC, H4A 3J1, Canada.
Department of Oncology, Division of Cancer Epidemiology, McGill University, 546 Pine Avenue West, Montréal, QC, H2W 1S6, Canada.
J Neurooncol. 2017 May;132(3):419-426. doi: 10.1007/s11060-017-2383-2. Epub 2017 Apr 3.
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.
复发性胶质母细胞瘤（GBM）的最佳治疗方案尚未确定。我们旨在评估再次手术和挽救性治疗（化疗和/或再次放疗）对复发性GBM的益处，并确定与更好生存相关的预后因素。本回顾性研究纳入了2005年1月至2012年12月期间接受GBM手术并接受辅助放疗，且影像学检查发现GBM复发的所有患者。使用Cox模型进行单因素和多因素分析，以确定与总生存期（OS）相关的因素。180例接受60 Gy剂量治疗的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例患者基于影像学检查因复发接受了再次手术。为确定再次手术和挽救性治疗的益处，将68例接受再次手术的患者与未接受再次手术的患者进行匹配，匹配因素为初次切除范围和复发时脑室下区受累情况。接受再次手术患者的MS为9.6个月，未接受再次手术患者的MS为5.3个月（p < 0.0001）。配对多因素分析证实，再次手术联合其他挽救性治疗可显著影响患者预后（风险比0.53）。复发性GBM再次手术联合其他挽救性治疗可在疾病进展时延长生存期。
