Tumour progression after initial maximal safe resection and Stupp protocol; impact of re-resection and prognostic factors on survival
Target Population
Patients with recurrent glioblastoma undergoing re-resection
Care Setting
Neuro-oncology surgical and multidisciplinary oncology care
Key Highlights
Glioblastoma is the most common primary malignant brain tumour with poor prognosis despite standard multimodal therapy.
Re-resection is performed in 10-30% of recurrent GBM cases but its survival benefit remains controversial.
This meta-analysis quantitatively assesses prognostic factors influencing survival after re-resection to guide personalized treatment.
Guideline-Based Recommendations
Diagnosis
Use WHO 2021 classification defining glioblastoma as IDH-wildtype grade 4 glioma.
Apply RANO criteria for defining tumour progression including new lesions, increased T2/FLAIR signal, clinical deterioration, and corticosteroid needs.
Management
Initial treatment: maximal safe resection followed by radiotherapy and concomitant/adjuvant temozolomide (Stupp protocol).
For recurrence, consider re-resection in selected patients based on performance status, neurological function, age, and prior treatments.
Other options include nitrosoureas, additional temozolomide, bevacizumab, and repeat radiation as per EANO guidelines.
Monitoring & Follow-up
Regular imaging and clinical assessment using RANO criteria to detect progression.
Monitor corticosteroid requirements and neurological status to assess tumour impact.
Risks
Re-resection carries surgical risks and its survival benefit is uncertain; patient selection is critical.
Heterogeneity in patient factors and tumour biology influences outcomes.
Patient & Prescribing Data
Patients with recurrent glioblastoma undergoing re-resection, predominantly IDH-wildtype.
Survival benefit of re-resection varies; extent of resection and molecular markers (e.g., MGMT methylation) are important prognostic factors influencing outcomes.
Clinical Best Practices
Perform maximal safe resection at initial diagnosis followed by Stupp protocol.
Use RANO criteria for accurate assessment of tumour progression.
Select patients for re-resection based on comprehensive evaluation including Karnofsky Performance Status, neurological function, age, and prior treatments.
Incorporate molecular classification (IDH status) in prognostic assessment and treatment planning.
Apply meta-analytic evidence to personalize treatment strategies for recurrent GBM.
by Manuel V. Baby, Rithvik M. Narendranath, Symriti Kaur-Paneser, Daniele S. C. Ramsay, Hariharan Subbiah Ponniah, Srikar R. Namireddy, Ahmed Salih, Ahkash Thavarajasingam, Daniel Scurtu, Andreas Kramer, Veit Stöcklein, Darius Kalasauskas, Dragan Jankovic, Florian Ringel, Santhosh G. Thavarajasingam
