Radical surgery and reoperation in supratentorial malignant glial tumors

The treatment modalities for gliomas are still questioning and searching. W e reviewed the effect of the extent of surgical resection and reoperation o n the length and quality of survival in 152 consecutive patients who underw ent operation for supratentorial gliomas at GATA Neurosurgery clinic betwee n 1985 to 1995. Seventy-two patients (50%) had glioblastoma multiforme (GBM ), and 48 patients (33%) had anaplastic astrocytoma (AA). Cross total resec tion was achieved in 70 cases (49%), subtotal resection was performed in 60 cases (42%), and biopsy was carried out in 14 cases (9%). Thirty-two patie nts were reoperated for recurrency and the median interval between the firs t operation and reoperation was 9.5 months in glioblastoma multiforme, and 11.7 months in anaplastic astrocytoma. The resection groups were compared f or age, sex, preoperative and postoperative Karnofsky rating, tumor locatio n, postoperative radiation therapy, and chemotherapy, and survival accordin g to multivariate analysis. Preoperative Karnofsky rating and surgical rese ction type were the most important factors related to survival after operat ion or reoperation. The gross total resection group lived longer than the s ubtotal resection group by life table analysis. Median survival of GBM was 76 weeks in gross total resection group, and 33 months in AA group with tot al resection (p < 0.001). Preoperative Karnofsky scores had a statistically significant effect on the quality of life and survival after operation and reoperation in all cases (p=0.005). Radical surgery and reoperation also i mprove quality and length of life in selective malignant supratentorial gli omas.