SURGICAL RESECTION AND RADIATION-THERAPY VERSUS BIOPSY AND RADIATION-THERAPY IN THE TREATMENT OF GLIOBLASTOMA-MULTIFORME

There has been considerable controversy over the concept of treating g lioblastoma multiforme with cytoreductive surgery. Therefore, a retros pective study of cases treated between 1986 and 1991 was conducted to analyze and compare the results of stereotactic biopsy followed by rad iation therapy performed in 58 patients with those of surgical resecti on plus radiation therapy in 57 patients. In both groups, conventional ly fractionated radiation (1.7 to 2.0 Gy/day) was delivered, with a to tal dose of 50 to 60 Gy. Biopsy was performed only in patients with tu mors judged to be inoperable. These patients carried a higher surgical risk and were in worse neurological condition than the patients in th e resection group. The median survival time for the resection group wa s 39.5 weeks, as compared with 32 weeks for the biopsy group. This dif ference was not significant. The most important prognostic factor was the patient's age. The treatment variable biopsy versus resection did not reach prognostic relevance. In patients with midline shift who und erwent biopsy, the Karnofsky Performance Scale score decreased in more patients during radiation therapy. The clinical status 6 weeks after surgery, however, showed no significant differences between the two gr oups. The comparable survival times for the two groups place doubt on the concept of treating glioblastoma multiforme with cytoreductive sur gery. Presently, radiation therapy is the most effective treatment for patients with glioblastoma. There is no question that decompressive s urgery followed by radiation therapy should be performed whenever nece ssary for severe space-occupying lesions and when it will not cause ne w neurological deficits.