Survival Benefit of Maximal Resection for Glioblastoma Reoperation in the Temozolomide Era

A Meta-Analysis

Victor M. Lu, Anshit Goyal, Christopher S. Graffeo, Avital Perry, Terence Burns, Ian F Parney, Alfredo Quinones-Hinojosa, Kaisorn L. Chaichana

Research output: Contribution to journalReview article

Abstract

Background: Although reoperation likely confers survival benefit for glioblastoma, whether the extent of resection (EOR) of the reoperation affects survival outcome has yet to be thoroughly evaluated in the current temozolomide (TMZ) era. The aim of this meta-analysis was to pool the current literature and evaluate the prognostic significance of reoperation EOR for glioblastoma recurrence in the current TMZ era. Methods: Searches of 7 electronic databases from inception to January 2019 were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There were 1203 articles identified for screening. Prognostic hazard ratios (HRs) for overall survival (OS) derived from multivariate regression analysis were analyzed using meta-analysis of proportions. Results: Nine individual studies satisfied all selection criteria, describing survival in 1507 patients with glioblastoma, including 1335 reoperations for recurrence (89%). When studies incorporated the EOR of index surgery into their analysis, maximal resection at reoperation was significantly prognostic for longer OS (HR, 0.59; 95% confidence interval [CI], 0.43–0.79; I 2 = 0%; P heterogeneity <0.01). When studies did not incorporate the EOR of index surgery into their analysis, maximal resection remained significantly prognostic for longer OS at reoperation (HR, 0.53; 95% CI, 0.45–0.64; I 2 = 5.2%; P heterogeneity <0.01). Based on EOR, radiographic gross total resection (GTR) was the most prognostic EOR definition at reoperation (HR, 0.52; 95% CI, 0.44–0.61; I 2 = 0%; P heterogeneity <0.01). Conclusions: In the current TMZ era, when reoperation is feasible for recurrent glioblastoma, maximal safe resection appears to confer a significant OS benefit based on the current literature. This benefit is most pronounced with radiographic GTR, and likely irrespective of EOR at index surgery.

Original languageEnglish (US)
Pages (from-to)31-37
Number of pages7
JournalWorld neurosurgery
Volume127
DOIs
StatePublished - Jul 1 2019

Fingerprint

temozolomide
Glioblastoma
Reoperation
Meta-Analysis
Survival
Confidence Intervals
Recurrence
Patient Selection

Keywords

  • Extent of resection
  • Glioblastoma
  • Gross total resection
  • Recurrence
  • Reoperation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Survival Benefit of Maximal Resection for Glioblastoma Reoperation in the Temozolomide Era : A Meta-Analysis. / Lu, Victor M.; Goyal, Anshit; Graffeo, Christopher S.; Perry, Avital; Burns, Terence; Parney, Ian F; Quinones-Hinojosa, Alfredo; Chaichana, Kaisorn L.

In: World neurosurgery, Vol. 127, 01.07.2019, p. 31-37.

Research output: Contribution to journalReview article

Lu, Victor M. ; Goyal, Anshit ; Graffeo, Christopher S. ; Perry, Avital ; Burns, Terence ; Parney, Ian F ; Quinones-Hinojosa, Alfredo ; Chaichana, Kaisorn L. / Survival Benefit of Maximal Resection for Glioblastoma Reoperation in the Temozolomide Era : A Meta-Analysis. In: World neurosurgery. 2019 ; Vol. 127. pp. 31-37.
@article{a8ce2a9d57d44f90a192024f94b9cd91,
title = "Survival Benefit of Maximal Resection for Glioblastoma Reoperation in the Temozolomide Era: A Meta-Analysis",
abstract = "Background: Although reoperation likely confers survival benefit for glioblastoma, whether the extent of resection (EOR) of the reoperation affects survival outcome has yet to be thoroughly evaluated in the current temozolomide (TMZ) era. The aim of this meta-analysis was to pool the current literature and evaluate the prognostic significance of reoperation EOR for glioblastoma recurrence in the current TMZ era. Methods: Searches of 7 electronic databases from inception to January 2019 were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There were 1203 articles identified for screening. Prognostic hazard ratios (HRs) for overall survival (OS) derived from multivariate regression analysis were analyzed using meta-analysis of proportions. Results: Nine individual studies satisfied all selection criteria, describing survival in 1507 patients with glioblastoma, including 1335 reoperations for recurrence (89{\%}). When studies incorporated the EOR of index surgery into their analysis, maximal resection at reoperation was significantly prognostic for longer OS (HR, 0.59; 95{\%} confidence interval [CI], 0.43–0.79; I 2 = 0{\%}; P heterogeneity <0.01). When studies did not incorporate the EOR of index surgery into their analysis, maximal resection remained significantly prognostic for longer OS at reoperation (HR, 0.53; 95{\%} CI, 0.45–0.64; I 2 = 5.2{\%}; P heterogeneity <0.01). Based on EOR, radiographic gross total resection (GTR) was the most prognostic EOR definition at reoperation (HR, 0.52; 95{\%} CI, 0.44–0.61; I 2 = 0{\%}; P heterogeneity <0.01). Conclusions: In the current TMZ era, when reoperation is feasible for recurrent glioblastoma, maximal safe resection appears to confer a significant OS benefit based on the current literature. This benefit is most pronounced with radiographic GTR, and likely irrespective of EOR at index surgery.",
keywords = "Extent of resection, Glioblastoma, Gross total resection, Recurrence, Reoperation",
author = "Lu, {Victor M.} and Anshit Goyal and Graffeo, {Christopher S.} and Avital Perry and Terence Burns and Parney, {Ian F} and Alfredo Quinones-Hinojosa and Chaichana, {Kaisorn L.}",
year = "2019",
month = "7",
day = "1",
doi = "10.1016/j.wneu.2019.03.250",
language = "English (US)",
volume = "127",
pages = "31--37",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Survival Benefit of Maximal Resection for Glioblastoma Reoperation in the Temozolomide Era

T2 - A Meta-Analysis

AU - Lu, Victor M.

AU - Goyal, Anshit

AU - Graffeo, Christopher S.

AU - Perry, Avital

AU - Burns, Terence

AU - Parney, Ian F

AU - Quinones-Hinojosa, Alfredo

AU - Chaichana, Kaisorn L.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: Although reoperation likely confers survival benefit for glioblastoma, whether the extent of resection (EOR) of the reoperation affects survival outcome has yet to be thoroughly evaluated in the current temozolomide (TMZ) era. The aim of this meta-analysis was to pool the current literature and evaluate the prognostic significance of reoperation EOR for glioblastoma recurrence in the current TMZ era. Methods: Searches of 7 electronic databases from inception to January 2019 were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There were 1203 articles identified for screening. Prognostic hazard ratios (HRs) for overall survival (OS) derived from multivariate regression analysis were analyzed using meta-analysis of proportions. Results: Nine individual studies satisfied all selection criteria, describing survival in 1507 patients with glioblastoma, including 1335 reoperations for recurrence (89%). When studies incorporated the EOR of index surgery into their analysis, maximal resection at reoperation was significantly prognostic for longer OS (HR, 0.59; 95% confidence interval [CI], 0.43–0.79; I 2 = 0%; P heterogeneity <0.01). When studies did not incorporate the EOR of index surgery into their analysis, maximal resection remained significantly prognostic for longer OS at reoperation (HR, 0.53; 95% CI, 0.45–0.64; I 2 = 5.2%; P heterogeneity <0.01). Based on EOR, radiographic gross total resection (GTR) was the most prognostic EOR definition at reoperation (HR, 0.52; 95% CI, 0.44–0.61; I 2 = 0%; P heterogeneity <0.01). Conclusions: In the current TMZ era, when reoperation is feasible for recurrent glioblastoma, maximal safe resection appears to confer a significant OS benefit based on the current literature. This benefit is most pronounced with radiographic GTR, and likely irrespective of EOR at index surgery.

AB - Background: Although reoperation likely confers survival benefit for glioblastoma, whether the extent of resection (EOR) of the reoperation affects survival outcome has yet to be thoroughly evaluated in the current temozolomide (TMZ) era. The aim of this meta-analysis was to pool the current literature and evaluate the prognostic significance of reoperation EOR for glioblastoma recurrence in the current TMZ era. Methods: Searches of 7 electronic databases from inception to January 2019 were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There were 1203 articles identified for screening. Prognostic hazard ratios (HRs) for overall survival (OS) derived from multivariate regression analysis were analyzed using meta-analysis of proportions. Results: Nine individual studies satisfied all selection criteria, describing survival in 1507 patients with glioblastoma, including 1335 reoperations for recurrence (89%). When studies incorporated the EOR of index surgery into their analysis, maximal resection at reoperation was significantly prognostic for longer OS (HR, 0.59; 95% confidence interval [CI], 0.43–0.79; I 2 = 0%; P heterogeneity <0.01). When studies did not incorporate the EOR of index surgery into their analysis, maximal resection remained significantly prognostic for longer OS at reoperation (HR, 0.53; 95% CI, 0.45–0.64; I 2 = 5.2%; P heterogeneity <0.01). Based on EOR, radiographic gross total resection (GTR) was the most prognostic EOR definition at reoperation (HR, 0.52; 95% CI, 0.44–0.61; I 2 = 0%; P heterogeneity <0.01). Conclusions: In the current TMZ era, when reoperation is feasible for recurrent glioblastoma, maximal safe resection appears to confer a significant OS benefit based on the current literature. This benefit is most pronounced with radiographic GTR, and likely irrespective of EOR at index surgery.

KW - Extent of resection

KW - Glioblastoma

KW - Gross total resection

KW - Recurrence

KW - Reoperation

UR - http://www.scopus.com/inward/record.url?scp=85064427395&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064427395&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2019.03.250

DO - 10.1016/j.wneu.2019.03.250

M3 - Review article

VL - 127

SP - 31

EP - 37

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -