Experiences with reoperation on recurrent glioblastoma multiforme

Objective: The goal was to report the treatment results after a second operation on patients with recurrent glioblastoma multiforme (GBM) and to investigate if patient's quality of life is improved and survival is lengthened. - Methods: Thirty-eight patients (17%) out of 224 patients with glioblastoma multiforme, treated at our department from 1/93 to 12/98, underwent re-operation due to clinical and neuroradiological significant recurrence of GBM. Not included were patients who had a lower malignant tumor at first operation and GBM on second operation. All 38 patients had completed radiation therapy. - Results: Overall median survival of re-operated patients was 57 weeks. Interval between 1(st) and 2(nd) operation was 42 weeks and median survival after 2(nd) operation was 23 weeks. Total survival was significantly longer in patients under 50 years at time of re-operation, a time interval longer than 26 weeks between 1(st) and 2(nd) operation, complete resection and a Karnofsky Performance Scale (KPS) greater than or equal to90 at the time of re-operation. Only in the subgroup Karnofsky Performance Scale more or equal 90 had a significant longer survival time after reoperation (29 weeks versus 18 weeks). Based on a KPS change of at least 10 points clinical status was improved in 22 patients. unchanged in 16 patients and no patient deteriorated. No perioperative mortality has occurred. - Conclusions:Prolongation of survival time after reoperation was statistically significant only in the Karnofsky Performance subgroup. In all other groups prolongation of survival was a relativ constant measure of 23% %weeks. The well known favorable prognostic indicators. such as younger age, longer event-free period. had also in our investigation the longest survival times.