Current trends in reoperation for recurrent glioblastoma: a meta-analysis (2007-2023).

PURPOSE

Despite conflicting evidence, reoperation for recurrent glioblastoma (rGBM) achieving complete resection of enhancing-tumor (CRET) may offer benefits over partial resection or salvage therapy alone. However, pooled analyses remain limited.

METHODS

A systematic search identified rGBM studies comparing reoperation and non-reoperation, including chemotherapy with/without radiotherapy, radiation-based therapies (RBT), and best supportive care (BSC).

RESULTS

Thirty-six studies, comprising 10,738 patients, were included, with 2,806 undergoing reoperation. Nine propensity-score-matched studies and one clinical trial were identified. Mean overall survival (OS) favored reoperation (19.66 months) over chemotherapy with/without radiotherapy (12.56 months, p < 0.00001) and BSC (4.04 months, p < 0.00001), but not over chemotherapy alone (14.60 months) or RBT (14.26 months)(p > 0.05). Multivariate OS favored reoperation over chemotherapy with/without radiation(HR = 0.62,95%CI:0.50-0.76,p < 0.00001), but not to stereotactic radiosurgery (SRS) (HR = 0.52,95%CI:0.25-1.08,p = 0.08) or chemotherapy alone (HR = 0.80,95%CI:0.63-1.00,p = 0.05). Progression-free survival after recurrence (PFS2) was only compared between reoperation and chemotherapy with/without radiotherapy, favoring reoperation (8.36 vs. 4.97 months, p < 0.00001). Multivariate analysis also favored reoperation (HR = 0.56, 95% CI:0.41-0.76,p = 0.0002).The mean post-recurrence survival (PRS) was 12.18 months in the reoperation group, 9.19 months in the chemotherapy with/without radiotherapy, and 9.64 months in SRS. Multivariate PRS favored reoperation over chemotherapy with/without radiotherapy (HR = 0.78, 95%CI: 0.62-0.98,p = 0.04). CRET with < 1 cm residual tumor correlated with improved PRS over incomplete resection (HR: 0.54, 95%CI:0.39-0.73, p = 0.04).

CONCLUSION

The role of reoperation in rGBM remains uncertain. While it may improve survival in selected cases, limited high-quality data hinder definitive conclusions. Achieving CRET may correlate with improved PRS over partial resection. Further prospective trials are necessary to guide optimal management of rGBM.