Hospices Civils de Lyon, Groupement Hospitalier Est, Hôpital Neurologique, Service de Neuro-oncologie, Lyon, France.
Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, F-75013, Paris, France.
Clin Neurol Neurosurg. 2020 Sep;196:106006. doi: 10.1016/j.clineuro.2020.106006. Epub 2020 Jun 8.
IDH wild-type glioblastoma is the most common and aggressive primary brain cancer in adults. At tumor recurrence, treatment decision-making is not standardized; several options include second surgery, reirradiation, and a second line of chemotherapy. In this retrospective monocentric study conducted at the era of WHO 2016 classification, we investigated IDH wild-type glioblastoma patients below the age of 70 to see (i) the clinical benefit of second surgery at recurrence and (ii) the prognostic factors in resected recurrent glioblastoma patients.
229 newly diagnosed IDH wild-type glioblastoma patients below the age of 70 treated with the standard of care (SOC) were enrolled in the current study and stratified into two subgroups according to treatment at recurrence: re-resection and no re-resection.
All experienced tumor recurrence with a median progression-free survival of 11 months. 25 % of patients were reoperated. Patients reoperated at recurrence had longer post-progression median overall survival compared to their non-reoperated counterparts (14 versus 9 months, p < .05). Initial surgical resection and a long time from the initial diagnosis to the first recurrence were independent prognostic factors for good outcomes in resected recurrent IDH-wild-type glioblastoma patients; however, tumor size before and after surgery did not impact post-surgical survival.
Our study supports surgical resection at recurrence as therapeutic in IDH wild-type glioblastoma patients aged below 70 and in good clinical condition regardless of preoperative tumor size, particularly in patients who experienced a longer time before first recurrence and surgery at initial diagnosis. Further prospective and larger studies are warranted to validate our findings.
异柠檬酸脱氢酶野生型胶质母细胞瘤是成人中最常见且侵袭性最强的原发性脑肿瘤。在肿瘤复发时，治疗决策尚未标准化；几种选择包括再次手术、再放疗和二线化疗。在本研究中，我们回顾性分析了 2016 年 WHO 分类时代年龄在 70 岁以下的 IDH 野生型胶质母细胞瘤患者，调查了（i）复发时再次手术的临床获益，以及（ii）切除后复发性胶质母细胞瘤患者的预后因素。
本研究纳入了 229 例年龄在 70 岁以下、接受标准治疗（SOC）的新诊断为 IDH 野生型胶质母细胞瘤患者，并根据复发时的治疗情况分为两组：再次手术和非再次手术。
所有患者均经历了肿瘤复发，无进展生存期的中位数为 11 个月。25%的患者接受了再次手术。与未再次手术的患者相比，再次手术的患者的无进展生存时间（14 个月对 9 个月）更长（p<0.05）。初始手术切除和从初始诊断到首次复发的时间间隔较长是复发性 IDH 野生型胶质母细胞瘤患者切除后良好结局的独立预后因素；然而，术前和术后肿瘤大小不影响术后生存。
我们的研究支持在 IDH 野生型胶质母细胞瘤患者年龄在 70 岁以下且临床状况良好的情况下，无论术前肿瘤大小如何，均可在复发时进行手术切除作为治疗方法，尤其是在首次复发和初始诊断时经历较长时间的患者中。需要进一步进行前瞻性和更大规模的研究来验证我们的发现。
