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Acta Neurochirurgica

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01-06-2011 | Clinical Article

Cytoreductive surgery of glioblastoma as the key to successful adjuvant therapies: new arguments in an old discussion

Authors: Walter Stummer, Martin J. van den Bent, Manfred Westphal

Published in: Acta Neurochirurgica | Issue 6/2011

Abstract

Background

This article discusses data from 3 randomized phase 3 trials, supporting a role for surgery in glioblastoma.

Methods

Data were reviewed by extent of resection during primary surgery from the ALA-Glioma Study (fluorescence-guided versus conventional resection), the BCNU wafer study (BCNU wafer versus placebo), and the EORTC Study 26981–22981 (radiotherapy versus chemoradiotherapy with temozolomide).

Results

For glioblastoma patients in the ALA study, median survival was 16.7 and 11.8 months for complete versus partial resection, respectively (P < 0.0001). Survival effects were maintained after correction for differences in age and tumor location. For glioblastoma patients who received ≥90% resection in the BCNU wafer study, median survival increased for BCNU wafer versus placebo (14.5 versus 12.4 months, respectively; P = 0.02), but no survival increase was found for <90% resection (11.7 versus 10.6 months, respectively; P = 0.98). In the EORTC study, absolute median gain in survival with chemoradiotherapy versus radiotherapy was greatest for complete resections (+4.1 months; P = 0.0001), compared with partial resections (+1.8 months; P = 0.0001), or biopsies (+1.5 months; P = 0.088), suggesting surgery enhanced adjuvant treatment.

Conclusion

Complete resection appears to improve survival and may increase the efficacy of adjunct/adjuvant therapies. If safely achievable, complete resection should be the surgical goal for glioblastoma.

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Title: Cytoreductive surgery of glioblastoma as the key to successful adjuvant therapies: new arguments in an old discussion
Authors: Walter Stummer
Martin J. van den Bent
Manfred Westphal
Publication date: 01-06-2011
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 6/2011
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-011-1001-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cytoreductive surgery of glioblastoma as the key to successful adjuvant therapies: new arguments in an old discussion

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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