Selection of eligible patients with supratentorial glioblastoma multiformefor gross total resection

The purpose of this study is to clarify whether gross total tumor resection can prolong the survival in adult patients with supratentorial glioblastom a multiforme (GBM), and to clarify what subset of these patients obtains a survival advantage by gross total tumor resection without postoperative neu rological deterioration. Eighty-two adult patients with supratentorial GBM were retrospectively revi ewed. Overall, the median survival time was 13 months, and the 1- and 2-yea r survival rates were 53.7% and 14.6%, respectively. In a univariate analys is for survival rate by log-rank test, age (< 40 years), Karnofsky performa nce scale (KPS) score (70-100%) and extent of surgery (gross total resectio n) were revealed to be significant good prognostic factors. A Cox proportio nal hazard multivariate regression analysis confirmed that the KPS and exte nt of surgery were independent, significant good prognostic factors. Nine p atients (11%) suffered postoperative neurological deterioration. A topographical GBM staging system (Stages I, II and III) with the integrat ion of tumor location, size and eloquence of adjacent brain based on MRI (f or explanation of Stages see text) was originally proposed. In Stage I, gro ss total resection had a strong tendency toward a better prognostic factor in a univariate analysis and was revealed to be a significant independent g ood prognostic factor in a multivariate analysis. In also Stage II, the sur vival of patients who underwent gross total resection was better than that of patients with less than gross total resection, although not significant. In Stage III, there were no patients who underwent gross total tumor resec tion. Risk probabilities of postoperative neurological deterioration, overa ll, were 0%, 22.2%, and 20% in Stages I, II, and III, respectively, and tho se after gross total resection were 0% and 16.7% in Stages I and II, respec tively. Although gross total tumor resection is associated with prolongation of the survival time of patients with GBM, the risk of postoperative neurological deficit increases with radical tumor resection. To select an eligible subs et of patients that benefit in survival from gross total tumor resection wi thout postoperative risk, the following surgical policy for GBM resection i s suggested. GBM in Stage I should be resected as radically as possible. Re garding Stage II, risky surgical resection extending to the area adjacent t o the critical zone should be avoided and more meticulous and careful surgi cal planning is needed than that in Stage I. In Stage III, radical gross to tal tumor resection is not recommended at present.