OBJECTIVES:

High grade glioma (HGGs), including grade III anaplastic astrocytoma (AA) and grade IV glioblastoma, are the most aggressive malignant brain tumors. Patients with glioblastoma and AA receive maximal safe resection plus conventionally fractionated external beam radiotherapy with concurrent administration of the alkylating agent temozolomide, followed by maintenance temozolomide as standard of care treatment. Despite aggressive treatment, nearly all HGGs eventually recur, with no standard of care treatment established for this patient population. In the recurrent setting, approved therapies such as chemotherapy lomustine and temozolomide and antibody therapy bevacizumab have been approved but the improvement in overall survival is minimal. In addition, surgery (re-resection) is not a common procedure for patients with recurrent HGG since no strong data suggest surgery has efficacy benefits except for reducing tumor burden and pressure in the brain. The objective of this meta-analysis is to understand whether surgery in the recurrent setting (first and second recurrence) would have any efficacy benefits to patients.

METHODS

: To keep the meta-analysis less complex, patients with experimental treatments were excluded from the analysis. Specifically, three groups of patients were identified and studied: 1. Approved therapies alone; 2. Surgery alone; 3. Approved therapies with surgery. Six efficacy endpoints were examined, and a total of 42 manuscripts were eligible for this meta-analysis.

RESULTS

: The analysis showed an significantly improved mOS for patients who received surgery and approved therapy compared to patients who received approved therapy alone (10.1 months vs. 5.7 months; p-value = 0.0088) while the other efficacy endpoints showed a trend of improvement but did not demonstrate a statistical significance due to the lack of sufficient data/manuscripts for a proper meta-analysis.

CONCLUSIONS

: Overall, this work provides evidence of efficacy benefit when patients receive surgery in the recurrent HGG setting.