Is reoperation for recurrence of glioblastoma justified?

The purpose of the present study was to determine the effect of surgery on the time length and quality of survival in patients with recurrent glioblas toma multiforme. Two groups were compared; the first included 18 patients w ho underwent surgery at the time of tumour recurrence. The second group inc luded 36 patients who did not undergo surgery at the time of tumour recurre nce. Both groups were matched according to the following criteria: gender, age, Karnofsky Performance Scale (KPS) score, at the time of initial surger y and of tumour recurrence, extent of initial surgery, interval between ini tial surgery and tumour reccurence. Both groups received conventional treat ment after initial surgery. There are no statistically significant differen ces between the two groups as regards to the previously mentioned criteria. After tumour recurrence, the median survival time was 5 months in the grou p of patients undergoing a second resection and 2 months in the group of pa tients not undergoing repeat surgery. The difference was statistically sign ificant on univariate analysis. Moreover, the median length of time spent i n an acceptable condition (KPS greater than or equal to 60) from the time o f tumour recurrence was found to be significantly longer in patient who und erwent a second resection (4 months) compared with patients who did not und ergo repeat surgery (1 month). Even in a relatively favorable subgroup of r eoperated patients, the survival benefit although significant was only 3 mo nths. Tt was impossible to completely match the two groups of patients sugg esting that the difference might have been even less. Although symptomatic improvement is modestly achieved by repeat surgery, its transient nature ne cessitates clear discussion with patient and family on an individual basis.