Repeated Surgeries May Extend Life of Brain Cancer Patients

Glioblastoma multiforme (GBM) is by far the most common and most malignant of the glial tumors. Of the estimated 17,000 primary brain tumors diagnosed in the United States each year, approximately 60 percent are gliomas.

Glioblastomas are cancerous tumors that become deeply intertwined with healthy brain tissue and, as a result, are difficult to remove. They are difficult to eradicate with surgery alone. 

A new study according to John Hopkins research suggest that the people who undergo repeated surgeries to remove glioblastomas, may survive longer than those who underdog a single operation.

Attention was recently drawn to this form of brain cancer when Senator Ted Kennedy was diagnosed with glioblastoma and ultimately died from it. 

According to the experts, the median survival time after diagnosis is only 14 months. With recurrence a near certainty many have questioned the value of performing second, third or even fourth operations, especially given the dangers of brain surgery, including the risk of neurological injury or death.

"We are reluctant to operate on patients with brain cancer multiple times as we are afraid to incur new neurological deficits or poor wound healing, and many times we are pessimistic about the survival chances of these patients," says Alfredo Quinones-Hinojosa, M.D., a professor of neurosurgery at the Johns Hopkins University School of Medicine and leader of the study.

"But this study tells us that the more we operate, the longer they may survive. We should not give up on these patients."

Nearly 578 patients records were reviewed by Quinones-Hinojosa and his team. These patients had undergone surgery to remove a glioblastoma between 1997 and 2007 at The Johns Hopkins Hospital.

At the last follow-up, 354 patients had one surgery, 168 had two resections, and 41 and 15 patients had three and four operations, respectively. The median survival for patients who underwent one, two, three and four operations was 6.8 months, 15.5 months, 22.4 months and 26.6 months, respectively.

Quinones-Hinojosa states that this analysis may overestimate the value of multiple surgeries based on patient selection, and that it's possible that the patients who did better had tumors with a biology that predisposed them to live longer. Further research will need to confirm his more positive conclusion.

"The only thing that has been proven to work for glioblastoma throughout history is surgery," Quinones-Hinojosa says. "Without surgery, these patients don't have much of a chance."

Quinones-Hinojosa says, "With each successive surgery, the procedure itself becomes more technically challenging as the anatomy changes, blood vessels are damaged and tissues become frail."

The study was published recently in the Journal Neurosurgery.