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Repeat surgery of recurrent glioma for molecularly informed treatment in the age of precision oncology: A risk-benefit analysis.
Alhalabi, Obada T; Dao Trong, Philip; Kaes, Manuel; Jakobs, Martin; Kessler, Tobias; Oehler, Hannah; König, Laila; Eichkorn, Tanja; Sahm, Felix; Debus, Jürgen; von Deimling, Andreas; Wick, Wolfgang; Wick, Antje; Krieg, Sandro M; Unterberg, Andreas W; Jungk, Christine.
Affiliation
  • Alhalabi OT; Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
  • Dao Trong P; Department of Neurosurgery, Medical Faculty, Heidelberg University, Heidelberg, Germany.
  • Kaes M; Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
  • Jakobs M; Department of Neurosurgery, Medical Faculty, Heidelberg University, Heidelberg, Germany.
  • Kessler T; Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
  • Oehler H; Department of Neurosurgery, Medical Faculty, Heidelberg University, Heidelberg, Germany.
  • König L; Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
  • Eichkorn T; Department of Neurosurgery, Medical Faculty, Heidelberg University, Heidelberg, Germany.
  • Sahm F; Department of Neurosurgery, Division for Stereotactic Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany.
  • Debus J; Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
  • von Deimling A; Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.
  • Wick W; Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
  • Wick A; Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.
  • Krieg SM; Department of Radiation Oncology, Heidelberg Ion Beam Therapy Centre (HIT), National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg University Hospital, Heidelberg, Germany.
  • Unterberg AW; Department of Radiation Oncology, Heidelberg Ion Beam Therapy Centre (HIT), National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg University Hospital, Heidelberg, Germany.
  • Jungk C; Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany.
J Neurooncol ; 167(2): 245-255, 2024 Apr.
Article in En | MEDLINE | ID: mdl-38334907
ABSTRACT

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.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Brain Neoplasms / Glioma Type of study: Etiology_studies / Guideline / Risk_factors_studies Limits: Humans Language: En Journal: J Neurooncol Year: 2024 Type: Article Affiliation country: Germany

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Brain Neoplasms / Glioma Type of study: Etiology_studies / Guideline / Risk_factors_studies Limits: Humans Language: En Journal: J Neurooncol Year: 2024 Type: Article Affiliation country: Germany