Stereotactic Radiosurgery Versus Reoperation in Small Surgically Accessible Recurrent Glioblastoma.
retrospective_cohort · Level III
Where this comes from
- Record sourced from PubMed, PMID 42200661.
- Also identified by DOI 10.1227/neu.0000000000004091.
- No licence information is recorded for this record.
- Because redistribution is not established, this page shows the abstract only. Follow the links below for the full text.
Abstract
Even with multimodal therapy, glioblastoma invariably recurs. Reirradiation with stereotactic radiosurgery (SRS) and reoperation are frequent salvage treatment options for recurrent glioblastoma (rGBM) isocitrate dehydrogenase-wildtype. No study has compared the safety and efficacy of these treatments in a homogeneous rGBM population. In this study, we evaluate gamma knife (GK)-SRS vs reoperation in rGBM. This retrospective study evaluated surgically accessible rGBM between 2005 and 2022. All patients received adjuvant radiotherapy and were evaluated for GK-SRS or reoperation on recurrence. Cox multivariable analysis and propensity-score matching were performed to address confounders in outcomes. Post-recurrence survival (PRS) was the primary endpoint. We identified 119 patients. Among these, 38 underwent GK-SRS and 81 underwent reoperation. Although patients undergoing GK-SRS had improved PRS and overall survival compared with reoperation, they had significant differences in baseline characteristics, particularly in tumor volume (reoperation group: 8.7 cm3 [IQR = 3.4-17.8 cm3] vs GK-SRS 1.7 cm3 [IQR = 0.2-6 cm3], P < .001). Given these significant differences, a propensity-score matching accounting for tumor volume and Karnofsky performance status was performed, comparing patients in which equipoise between GK-SRS and resection existed (GK-SRS 2.5 cm3 vs reoperation 2.6 cm3 and Karnofsky performance status 80 for both). Among these patients (23 in each group), PRS (19.2 months vs 15.1 months, P = .617) and overall survival (31.9 months vs 25.5 months, P = .176) were similar. Nevertheless, complications remained higher in the reoperation group (26.1% vs 4.3%, P = .040). In patients with small, surgically accessible first recurrent glioblastoma, GK-SRS achieved survival outcomes comparable to reoperation after matching for key baseline differences, while demonstrating a lower complication rate. These findings support GK-SRS as a reasonable local salvage option in carefully selected low-volume recurrences.