Medical Student Oregon Health and Science University Portland, Oregon, United States
Introduction: Glioblastoma (GBM) requires vigilant surveillance after primary resection due to nearly inevitable disease recurrence. Reoperation for recurrent disease remains controversial but is commonly offered to maximize quality of life and functional status. Patients may wait a variable amount of time for repeat resection after imaging diagnosis of recurrent disease for an array of factors. Our study evaluates whether the period of time between progression and date of second surgery affects overall survival.
Methods: In a retrospective cohort study, we reviewed 39 high grade glioma patients who received a second resection at Oregon Health and Science University between 2012-2022. Wait time was considered days from date of noted progression on imaging to date of second resection. Redo surgeries to further debulk residual primary tumor were excluded. Patients who were lost to follow up or did not receive standard therapy after initial resection were excluded. Recursive partitioning analysis (RPA) was employed to automatically detect a cut point of wait time based on survival probability.
Results: 16 patients waited < 1month for repeat resection, 13 waited 1 month, 10 waited >1month. There was no significant difference in the overall survival between the different wait times. RPA found wait times greater than 32 days predict worse survival probability though this was non-significant. 7 patients had another course of chemotherapy or radiation (CRT) prior to repeat resection and had significantly worse survival. Patients who presented to the emergency department and were found to have progression had significantly worse survival than those whose progression was found on screening imaging.
Conclusion : We found there is no difference in overall survival and functional status because of time to repeat resection. However, GBM patients who undergo second CRT before surgery and GBM patients whose progression is found emergently had significantly worse survival after repeat resection compared to other repeat resection patients.
