Survival rate increases with resections for those with glioblastomas
Glioblastomas are the most aggressive and deadliest type of brain tumors. These tumors derive from the star shaped cells (astrocytes) that make up the supportive tissue of the brain. These tumors are highly cancerous as a result of the cells reproducing quickly and are supported by a large network of blood vessels according to the American Brain Tumor Association. The average survival rate for glioblastoma patients is fourteen months however; researchers from John Hopkins find that patients may live longer by having repeated surgeries instead of just one surgery.
The brain cancer glioblastomas took the lives of several notable names including Senator Edward Kennedy and George Gershwin. The tumor unavoidably returns after surgery to remove the tumor, chemotherapy and or radiation. Inevitability the tumors recur with almost certainty that experts say many have brought into question the value of performing a second, third or even fourth operation particularly due to the dangers of brain surgery including the risk of neurological injury or death.
The goal of this study was to examine if patients who underwent resections (the partial removal of an organ or other body structure) experienced improved survival in comparison to patients with less resections, according to the studies abstract.
Dr. Alfredo Quiñones-Hinojosa, MD, Professor of Neurosurgery and Oncology, Neuroscience and Cellular and Molecular Medicine at Johns Hopkins, the director of the Brain Tumor Surgery Program at the Johns Hopkins Bayview Campus and leader of study stated “We are reluctant to operate on patients with brain cancer multiple times as we are afraid to incur new neurological deficits or poor wound healing, and many times we are pessimistic about the survival chances of these patients.” “But this study tells us that the more we operate, the longer they may survive. We should not give up on these patients.”
For this study Dr. Quiñones-Hinojosa and his research team reviewed the records of 578 adult patients who underwent surgery to remove a glioblastoma between 1997 and 2007 at The Johns Hopkins Hospital. At last follow-up 354 patients underwent one surgery, 168 patients two surgeries, 41 patients three surgeries an d 15 patients four surgeries.
The median survival for patients who underwent 1, 2, 3, and 4 resections was 6.8, 15.5, 22.4, and 26.6 months respectively. In multivariate analysis, patients who underwent only 1 resection experienced shortened survival compared with patients who underwent 2,3 or four surgeries.
In their conclusion the researchers wrote “The present study shows that patients with recurrent glioblastoma can have improved survival with repeated resections. The findings of this study, however, may be limited by an intrinsic bias associated with patient selection. The authors attempted to minimize these biases by using strict inclusion criteria, multivariate analyses, and case-control evaluation.” “Further research will need to confirm his more positive conclusion.”
Dr. Quiñones-Hinojosa stated “The only thing that has been proven to work for glioblastoma throughout history is surgery, without surgery, these patients don’t have much of a chance.”
Besides reducing the tumors size, repeated surgeries may also increase the effectiveness of chemotherapy and radiation.
Patients, their families and their doctors must determine whether repeated surgery is the best course of action, weighing the potential risks against the potential benefits, according to Dr. Quiñones-Hinojosa. He adds that this procedure should only be performed if it can be done with relative safety and patients can tolerate anesthesia and the long recovery period.
This study is published online in the Journal of Neurosurgery.
In 2008, Mayo Clinic researchers had found that patients with low-grade gliomas survived longest when they underwent aggressive surgeries to successfully remove the entire tumor. If it was not safe to remove the entire tumor patients still survived longer by having surgery followed by radiation.
Dr. Nadia Laack, MD, radiation oncologist at the Mayo Clinic and lead author of the study commented “An average of 15 years tumor-free is better than any previously published results. It is also exciting to discover that patients can benefit from radiation therapy. It not only lengthens the time before the tumor comes back, it actually improves the length of time people live. This builds on previous Mayo Clinic data that suggested similar results from a small study published nearly 20 years ago.”
At the time of the study Dr. Laack noted that their findings may be controversial due to common concerns over possible long term side effects of radiation therapy. She added that the Mayo Clinic minimizes possible side effects by tightly focusing radiation therapy on the tumor.
Each year around 23,000 adults in the United States are diagnosed with primary brain tumors and around 60% of those are glioblastomas.
More information on treatment update of glioblastomas tumors is available online at Cancer Care.