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Influence of location and extent of surgical
resection on survival of patients with glioblastoma multiforme: results of three
consecutive Radiation Therapy Oncology Group (RTOG) clinical trials
Simpson JR, Horton J, Scott C, Curran WJ, Rubin P, Fischbach J, Isaacson S,
Rotman M, Asbell SO, Nelson JS, et al
Washington University.
Purpose. The influence of tumor site, size, and extent of surgery on
the survival of patients with glioblastoma multiforme treated on three
consecutive prospectively randomized Radiation Therapy Oncology Group trials
employing surgery and irradiation plus or minus chemotherapy was studied.
Methods and Materials. Six hundred forty-five patients with a
diagnosis of glioblastoma multiforme on central pathological review were
analyzed for survival with respect to known prognostic factors, that is, age and
Karnofsky Performance Status, as well as extent of surgery, site, and
size.
Surgical treatment consisted of biopsy only in 17%, partial resection in 64%,
and total resection in 19%.
Tumors were located in frontal lobe in 43%, temporal lobe in 28%, and parietal
lobe in 25%.
Maximum tumor diameter as determined on computed tomography or magnetic
resonance imaging scans was less than 5 cm for 38%, between 5-10 cm for 56% and
greater than 10 cm for 6% of patients.
The extent of surgical therapy was the same for tumors greater than 5 or greater
than 10 cm, whereas total resection was more often performed for tumors less
than 5 cm.
The extent of surgery did not appear to vary with age or site.
Results. Patients undergoing total resection had a median survival
of 11.3 months compared to 6.6 months for patients with a biopsy only.
A significant difference in median survival was also found for partial resection
versus biopsy only treatment (10.4 vs. 6.6 months).
There was no difference in survival for the different tumor sizes.
Patients with frontal lobe tumors survived longer than those with temporal or
parietal lobe lesions (11.4 months, 9.1 months, and 9.6 months, respectively) (p
= 0.01).
A Cox multivariate model confirmed a significant correlation of age, Karnofsky
Performance Status, extent of surgery, and primary site with survival.
The best survival rates occurred in patients who had at least three of the
following features: < 40 years of age, high Karnofsky Performance Status,
frontal tumors, and total resection (17 months median).
Conclusion. We conclude that biopsy only yields inferior survival to
more extensive surgery for patients with glioblastoma multiforme treated with
surgery and radiation therapy.
PMID: 8387988 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=8387988&dopt=Abstract
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