背景:多形性胶质母细胞瘤(GBM)是主要起源于颅内的恶性脑肿瘤。手术后既定的一线治疗是同步放化疗作为确定的措施。然而,复发性GBM对依靠机构经验来确定最合适的行动方案的临床医生构成了挑战。根据机构的实践,二线化疗可以有或没有手术。这项研究旨在介绍我们的三级中心机构对接受重做手术的复发性GBM患者的经验。
方法:在这项回顾性研究中,我们分析了2006年至2015年在皇家斯托克大学医院接受重做手术的复发性GBM患者的手术和肿瘤数据。第1组(G1)包括接受检查的患者,随机选择对照组(G2),按年龄匹配被审查的群体,初级治疗,无进展生存期(PFS)。这项研究收集了各种参数的数据,包括总生存率,PFS,手术切除的范围,术后并发症。
结果:这项回顾性研究包括30例G1期患者和32例G2期患者,根据年龄匹配,初级治疗,和PFS。该研究发现,从首次诊断开始,G1组的总生存期为109周(45-180),而G2组为57周(28-127)。二次手术后并发症的发生率为57%,其中包括出血,梗塞,由于水肿导致神经学恶化,脑脊液漏,和伤口感染。此外,G1组50%的患者接受了重做手术,接受了二线化疗。
结论:我们的研究发现,对于具有良好表现状态的选定患者组,复发性GBM的重做手术是可行的治疗选择,从初级治疗开始的PFS更长,和压缩症状。然而,重做手术的使用因机构而异。在该人群中进行精心设计的随机对照试验将有助于建立外科护理标准。
Glioblastoma multiforme (GBM) is the predominant malignant brain tumor originating intracranially. The established first-line treatment postsurgery is concurrent chemoradiation as a definitive measure. However, recurrent GBM\'s pose a challenge for clinicians who rely on institutional experience to determine the most suitable course of action. Second-line chemotherapy may be administered with or without surgery depending on the institution\'s practice. This study aims to present our tertiary center institution\'s experience with recurrent GBM patients who underwent redo surgery.
In this retrospective study we analyzed the surgical and oncological data of patients with recurrent GBM who underwent redo surgery at the Royal Stoke University Hospitals between 2006 and 2015. The group 1 (G1) comprised the reviewed patients, while a control group (G2) was randomly selected, matching the reviewed group by age, primary treatment, and progression-free survival (PFS). The study collected data on various parameters, including overall survival, PFS, extent of surgical resection, and postoperative complications.
This retrospective study included 30 patients in G1 and 32 patients in G2, matched based on age, primary treatment, and PFS. The study found that the overall survival for the G1 group from the time of first diagnosis was 109 weeks (45-180) compared to 57 weeks (28-127) in the G2 group. The incidence of postoperative complications after the second surgery was 57%, which included hemorrhage, infarction, worsening neurology due to edema, cerebrospinal fluid leak, and wound infection. Furthermore, 50% of the patients in the G1 group who underwent redo surgery received second-line chemotherapy.
Our study found that redo surgery for recurrent GBM is a viable treatment option for a select group of patients with good performance status, longer PFS from primary treatment, and compressive symptoms. However, the use of redo surgery varies depending on the institution. A well-designed randomized controlled trial in this population would help establish the standard of surgical care.