Surgery for Recurrent Glioblastoma

Abstract

Recurrence of glioblastoma (GB) is inevitable. As the optimal management for recurrent glioblastoma continues to evolve, clear treatment guidelines for are lacking. Existing literature does not clarify the role that second surgery plays in the treatment of these patients. Although few studies report that second surgery is beneficial in select patients and leads to longer overall survival (OS), other studies have demonstrated the limited impact that repeat surgery has on the eventual patient outcome. Maximal safe resection (high extent of resection—EOR) has been proven to improve the OS at reoperation, even when undertaken for cases where the first surgery achieved only a limited EOR. Karnofsky Performance Score (KPS) and age at presentation are valuable prognostic factors that predict better OS and aid in better patient selection for surgical management. The true value of reoperation versus systemic treatment, their effects the patient’s QoL and the added increase in overall survival is better judged after detailed investigation by means of a prospec-tive, randomized trial.