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Purpose <p>Despite conflicting evidence, reoperation for recurrent glioblastoma (rGBM) achieving complete resection of enhancing-tumor (CRET) may offer benefits over partial resection or salvage therapy alone. However, pooled analyses remain limited.</p> Methods <p>A systematic search identified rGBM studies comparing reoperation and non-reoperation, including chemotherapy with/without radiotherapy, radiation-based therapies (RBT), and best supportive care (BSC).</p> Results <p>Thirty-six studies, comprising 10,738 patients, were included, with 2,806 undergoing reoperation. Nine propensity-score-matched studies and one clinical trial were identified. Mean overall survival (OS) favored reoperation (19.66&#xa0;months) over chemotherapy with/without radiotherapy (12.56&#xa0;months, p &lt; 0.00001) and BSC (4.04&#xa0;months, p &lt; 0.00001), but not over chemotherapy alone (14.60&#xa0;months) or RBT (14.26&#xa0;months)(p &gt; 0.05). Multivariate OS favored reoperation over chemotherapy with/without radiation(HR = 0.62,95%CI:0.50–0.76,p &lt; 0.00001), but not to stereotactic radiosurgery (SRS) (HR = 0.52,95%CI:0.25–1.08,p = 0.08) or chemotherapy alone (HR = 0.80,95%CI:0.63–1.00,p = 0.05). Progression-free survival after recurrence (PFS2) was only compared between reoperation and chemotherapy with/without radiotherapy, favoring reoperation (8.36 vs. 4.97&#xa0;months, p &lt; 0.00001). Multivariate analysis also favored reoperation (HR = 0.56, 95% CI:0.41–0.76,p = 0.0002).The mean post-recurrence survival (PRS) was 12.18&#xa0;months in the reoperation group, 9.19&#xa0;months in the chemotherapy with/without radiotherapy, and 9.64&#xa0;months in SRS. Multivariate PRS favored reoperation over chemotherapy with/without radiotherapy (HR = 0.78, 95%CI: 0.62–0.98,p = 0.04). CRET with &lt; 1 cm<sup>3</sup> residual tumor correlated with improved PRS over incomplete resection (HR: 0.54, 95%CI:0.39–0.73, p = 0.04).</p> Conclusion <p>The role of reoperation in rGBM remains uncertain. While it may improve survival in selected cases, limited high-quality data hinder definitive conclusions. Achieving CRET may correlate with improved PRS over partial resection. Further prospective trials are necessary to guide optimal management of rGBM.</p>

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Current trends in reoperation for recurrent glioblastoma: a meta-analysis (2007–2023)

  • 期刊论文

  • 发表日期：

    2025年5月2日

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  • Pavel S. Pichardo-Rojas,
  • Fabricio Garcia-Torrico,
  • César B. Espinosa-Cantú,
  • Francisco A. Rodriguez-Elvir,
  • Andrea C. Beltran-De la Fuente,
  • Myriam S. Hernandez-Garcia,
  • James S. Trippett,
  • Alexis Morell,
  • Ashish H. Shah,
  • Ricardo J. Komotar,
  • Yoshua Esquenazi

摘要

Purpose

Despite conflicting evidence, reoperation for recurrent glioblastoma (rGBM) achieving complete resection of enhancing-tumor (CRET) may offer benefits over partial resection or salvage therapy alone. However, pooled analyses remain limited.

Methods

A systematic search identified rGBM studies comparing reoperation and non-reoperation, including chemotherapy with/without radiotherapy, radiation-based therapies (RBT), and best supportive care (BSC).

Results

Thirty-six studies, comprising 10,738 patients, were included, with 2,806 undergoing reoperation. Nine propensity-score-matched studies and one clinical trial were identified. Mean overall survival (OS) favored reoperation (19.66 months) over chemotherapy with/without radiotherapy (12.56 months, p < 0.00001) and BSC (4.04 months, p < 0.00001), but not over chemotherapy alone (14.60 months) or RBT (14.26 months)(p > 0.05). Multivariate OS favored reoperation over chemotherapy with/without radiation(HR = 0.62,95%CI:0.50–0.76,p < 0.00001), but not to stereotactic radiosurgery (SRS) (HR = 0.52,95%CI:0.25–1.08,p = 0.08) or chemotherapy alone (HR = 0.80,95%CI:0.63–1.00,p = 0.05). Progression-free survival after recurrence (PFS2) was only compared between reoperation and chemotherapy with/without radiotherapy, favoring reoperation (8.36 vs. 4.97 months, p < 0.00001). Multivariate analysis also favored reoperation (HR = 0.56, 95% CI:0.41–0.76,p = 0.0002).The mean post-recurrence survival (PRS) was 12.18 months in the reoperation group, 9.19 months in the chemotherapy with/without radiotherapy, and 9.64 months in SRS. Multivariate PRS favored reoperation over chemotherapy with/without radiotherapy (HR = 0.78, 95%CI: 0.62–0.98,p = 0.04). CRET with < 1 cm3 residual tumor correlated with improved PRS over incomplete resection (HR: 0.54, 95%CI:0.39–0.73, p = 0.04).

Conclusion

The role of reoperation in rGBM remains uncertain. While it may improve survival in selected cases, limited high-quality data hinder definitive conclusions. Achieving CRET may correlate with improved PRS over partial resection. Further prospective trials are necessary to guide optimal management of rGBM.