Cytoreductive surgery of glioblastoma as the key to successful adjuvant therapies: new arguments in an old discussion
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Walter Stummer & Martin J. van den Bent & Manfred Westpha
- چاپ و سال / کشور: 2011
Description
Background This article discusses data from 3 randomized phase 3 trials, supporting a role for surgery in glioblastoma. Methods Data were reviewed by extent of resection during primary surgery from the ALA-Glioma Study (fluorescenceguided versus conventional resection), the BCNU wafer study (BCNU wafer versus placebo), and the EORTC Study 26981.22981 (radiotherapy versus chemoradiotherapy with temozolomide). Results For glioblastoma patients in the ALA study, median survival was 16.7 and 11.8 months for complete versus partial resection, respectively (P<0.0001). Survival effects were maintained after correction for differences in age and tumor location. For glioblastoma patients who received .90% resection in the BCNU wafer study, median survival increased for BCNU wafer versus placebo (14.5 versus 12.4 months, respectively; P=0.02), but no survival increase was found for <90% resection (11.7 versus 10.6 months, respectively; P=0.98). In the EORTC study, absolute median gain in survival with chemoradiotherapy versus radiotherapy was greatest for complete resections (+4.1 months; P=0.0001), compared with partial resections (+1.8 months; P=0.0001), or biopsies (+1.5 months; P= 0.088), suggesting surgery enhanced adjuvant treatment. Conclusion Complete resection appears to improve survival and may increase the efficacy of adjunct/adjuvant therapies. If safely achievable, complete resection should be the surgical goal for glioblastoma.
Acta Neurochir (2011) 153:1211–1218 Received: 4 January 2011 / Accepted: 16 March 2011 / Published online: 9 April 2011
