Impact of combination therapy with repeat surgery and temozolomide for recurrent or progressive glioblastoma multiforme: a prospective trial

BackgroundThe purpose of this study is to evaluate the feasibility of repeat surgery combination with postoperative TMZ for adults with recurrent or progressive GBMs.MethodsOf 35 patients who had diagnoses of GBM between 2002 and 2005, 7 (20%) underwent second surgeries and TMZ for recurrent or progressive disease. We examined the case histories of these 7 patients and determined the location of tumor and extent of their surgical procedures. Using the KPS, we assessed each patient's neurologic state before and after initial and repeat surgery. We calculated survival times from time of initial surgery and compared actual survival with statistically predicted survival times for each patient.ResultsMedian survival rates were higher than predicted: The statistical risk estimate for median survival time after repeat surgery for these patients was 9 months; the actual survival time from initial operation until time of death averaged 15.1 months. The neurologic status before and after second surgery also averaged 76 points on KPS. Survival time did not depend on removing the entire tumor at initial and second surgery.ConclusionCombination with repeat surgery and TMZ improved overall survival of these GBM patients.