Published by the Students of Johns Hopkins since 1896
February 24, 2024

Multiple surgeries combat brain cancer

By EVA PEKLE | November 15, 2012

Recent studies show that survival rate increases with the number of surgeries patients with fatal brain cancer undergo.

The period of survival for patients who underwent multiple resections, the surgical removal of one part of an organ, is longer than for patients who only had one surgery, as in the case of glioblastoma.

Alfredo Quinones-Hinojosa, along with Kaisorn Chaichana and other fellows from the Departments of Neurosurgey and Neuro-oncology at Hopkins Medicine published a recent study in the Journal of Neurosurgery.

In the study, they investigated 578 cases of patients who suffered from glioblastoma multiform (GBM). Even though similar studies have been conducted at other institutions, this study used a more significant number of patients.

Glioblastoma multiform (GBM) is the most prevalent form of brain tumor, with 2-3 cases per 100,000 people in Europe and North America. It is known for recurring even after numerous treatments.

These tumors are able to migrate and affect a heterogeneous population of cell types. They are usually malignant because they reproduce quickly and are supplied by a large amount of blood vessels. Moreover, GBMs are difficult to remove, since they develop around healthy brain cells.

The median survival rate is 14 months. In addition, despite its frequent recurrence, multiple surgeries are not always performed.

This is because many other risks could arise, such as damage of neural tissue, which could lead to various neural deficits, and even death.

“Patients with GBM are plagued because their tumor comes back regardless of how much is removed. Theoretically, these patients may need several repeated resections. Very few surgeons are willing to offer this because each surgery becomes more difficult because of scarring, involvement of different and important brain structures, patients are usually not as healthy, etc. We show that repeated surgery may benefit these patients,” Chaichana wrote in an email to The News-Letter.

Records of 578 patients between 1997 and 2007 were reviewed. In these patients, 354 received one resection, 168 two resections, 41 and 15 received three and four resections respectively.

Results showed that the median survival rate for people who underwent one, two, three and four operations was 6.8 months, 15.5 months, 22.4 months and 26.6 months, respectively.

Multiple resections not only reduce the size of the tumor, but also enhance the efficacy of other treatments such as chemotherapy or radiotherapy.

However, each surgery becomes more challenging.

“Each individual brings with them a new set of circumstances and difficulties. But, in general, each repeated surgery is more difficult than the previous surgery. There is more scarring, which makes it more difficult to identify tissue planes. It is also difficult to sometimes differentiate between tumor and non-tumor tissue. Moreover, there are other issues such as wound healing and risk of infections. Also, patients may not be as healthy to tolerate repeat surgery because they have usually been through several trials of radiation and chemotherapy,” Chaichana wrote.

Even though these are promising results, some factors, such as the predisposition for longevity, were still variable. A future study to confirm the results could provide additional support.

“This study shows the value of repeated resections for GBM. A lot of institutions only offer these patients one surgery, and rely on adjuvant therapy thereafter. We show that there may be some utility in offering repeat resections of it is she to do so. Our study is retrospective in nature, and a prospective study would help verify our results,” Chaichana wrote.

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