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37 The impact of repeated surgery on survival for patients with recurrent glioblastoma

Published online by Cambridge University Press:  27 July 2018

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Abstract

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Background: Recurrent glioblastoma portends a poor prognosis and the role of repeat surgery in improving survival remains uncertain. Therefore, we undertook a systematic review and meta-analysis in order to determine if repeat surgical resection provides a meaningful survival benefit for patients with recurrent glioblastoma. Methods: Two independent reviewers searched for articles that reported on overall-survival of patients with recurrent glioblastoma using MEDLINE, Embase, Google Scholar, and Cochrane from January 2000 to 2018. Studies that compared overall survival of patients treated with single surgery compared to repeat surgery in the temozolomide era were included for analysis.Primary outcomes were odds ratio for survival at 6, 12, and 24 months from date of initial diagnosis. Secondary outcomes were ratio odds ratio for survival at 6, 12, and 24 months from date of repeat surgery. The proportions of patients who had the outcomes of interest were pooled using random-effects model. Quality assessment was performed using the Newcastle Ottawa Scale. Heterogeneity across trials was quantified by the I2 statistic. Publication bias was evaluated visually using funnel plots and quantified by the Egger regression. Results: Fourteen articles reporting on 3048 patients were included for analysis. The majority of articles were deemed to be of high quality with Newcastle Ottawa scale greater than 7 points. Pooled analysis showed improved overall survival following repeat surgery at 6- (OR 1.73, 95% CI 1.23-2.45, p<0.05), 12- (OR 1.71, 95% CI 1.20-2.45, p<0.05), and 24-months (OR 2.24,95% CI 1.01-4.95, p<0.05) and from date of initial diagnosis at 6- (OR 8.22, 95% CI 5.23-12.93, p<0.01), 12- (OR 4.16, 95% CI 3.25-5.36, p<0.01), and 24- (2.35, 95% CI 1.77-3.11, p<0.05) months. Conclusions: Repeat surgery for recurrent glioblastoma is associated with a significant survival advantage independent of other salvage therapies that include chemotherapy, radiation, and other antineoplastic regimens.

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© The Canadian Journal of Neurological Sciences Inc. 2018