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Repeat surgery of recurrent glioma for molecularly informed treatment in the age of precision oncology: a risk-benefit analysis

Purpose: Surgery for recurrent glioma provides cytoreduction and tissue for molecularly informed treatment. With mostly heavily pretreated patients involved, it is unclear whether the benefits of repeat surgery outweigh its potential risks. Methods: Patients receiving surgery for recurrent glioma WH...

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Main Authors: Alhalabi, Obada (Author) , Dao Trong, Huy Philip (Author) , Kaes, Manuel (Author) , Jakobs, Martin (Author) , Keßler, Tobias (Author) , Oehler, Hannah (Author) , König, Laila (Author) , Eichkorn, Tanja (Author) , Sahm, Felix (Author) , Debus, Jürgen (Author) , Deimling, Andreas von (Author) , Wick, Wolfgang (Author) , Wick, Antje (Author) , Krieg, Sandro (Author) , Unterberg, Andreas (Author) , Jungk, Christine (Author)
Format: Article (Journal)
Language:English
Published: 09 February 2024
In: Journal of neuro-oncology
Year: 2024, Volume: 167, Issue: 2, Pages: 245-255
ISSN:1573-7373
DOI:10.1007/s11060-024-04595-5
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1007/s11060-024-04595-5
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Author Notes:Obada T. Alhalabi, Philip Dao Trong, Manuel Kaes, Martin Jakobs, Tobias Kessler, Hannah Oehler, Laila König, Tanja Eichkorn, Felix Sahm, Jürgen Debus, Andreas von Deimling, Wolfgang Wick, Antje Wick, Sandro M. Krieg, Andreas W. Unterberg, Christine Jungk
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Summary:Purpose: Surgery for recurrent glioma provides cytoreduction and tissue for molecularly informed treatment. With mostly heavily pretreated patients involved, it is unclear whether the benefits of repeat surgery outweigh its potential risks. Methods: Patients receiving surgery for recurrent glioma WHO grade 2–4 with the goal of tissue sampling for targeted therapies were analyzed retrospectively. Complication rates (surgical, neurological) were compared to our institutional glioma surgery cohort. Tissue molecular diagnostic yield, targeted therapies and post-surgical survival rates were analyzed. Results: Between 2017 and 2022, tumor board recommendation for targeted therapy through molecular diagnostics was made for 180 patients. Of these, 70 patients (38%) underwent repeat surgery. IDH-wildtype glioblastoma was diagnosed in 48 patients (69%), followed by IDH-mutant astrocytoma (n = 13; 19%) and oligodendroglioma (n = 9; 13%). Gross total resection (GTR) was achieved in 50 patients (71%). Tissue was processed for next-generation sequencing in 64 cases (91%), and for DNA methylation analysis in 58 cases (83%), while immunohistochemistry for mTOR phosphorylation was performed in 24 cases (34%). Targeted therapy was recommended in 35 (50%) and commenced in 21 (30%) cases. Postoperatively, 7 patients (11%) required revision surgery, compared to 7% (p = 0.519) and 6% (p = 0.359) of our reference cohorts of patients undergoing first and second craniotomy, respectively. Non-resolving neurological deterioration was documented in 6 cases (10% vs. 8%, p = 0.612, after first and 4%, p = 0.519, after second craniotomy). Median survival after repeat surgery was 399 days in all patients and 348 days in GBM patients after repeat GTR. Conclusion: Surgery for recurrent glioma provides relevant molecular diagnostic information with a direct consequence for targeted therapy under a reasonable risk of postoperative complications. With satisfactory postoperative survival it can therefore complement a multi-modal glioma therapy approach.
Item Description:Online veröffentlicht: 09. Februar 2024
Gesehen am 11.06.2024
Physical Description:Online Resource
ISSN:1573-7373
DOI:10.1007/s11060-024-04595-5

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