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Extensive Surgery Best for an Aggressive Brain Cancer: Study

THURSDAY, June 16, 2016 -- When it comes to battling a particularly aggressive form of brain tumor, more extensive surgeries may be best to boost patient survival, researchers have concluded.

The brain cancer -- called glioblastoma multiforme -- is often treated with surgery, radiation therapy and chemotherapy. However, the ideal combination of treatments for this cancer isn't clear.

One expert said glioblastoma surgeries are especially complicated.

"Since this tumor infiltrates normal brain and is often indistinguishable from it, it is difficult to know where the tumor ends and normal brain begins," explained Dr. Raj Narayan, a neurosurgeon who reviewed the new study findings.

"Therefore, an aggressive effort to remove 'all' of the tumor runs the risk of causing increased neurological deficits such as paralysis and loss of speech," said Narayan, who is chair of neurosurgery at North Shore University Hospital, in Manhasset, N.Y.

Current surgical options for glioblastomas include performing a minimally invasive biopsy; a more moderate surgery where not all the tumor is removed; or opening the skull in an attempt to remove all the visible cancer.

However, which approach works best for patients hasn't been clear, said a team led by Dr. Michael Glantz of Penn State Milton S. Hershey Medical Center, in Hershey, Pa.

What is known is that total surgical removal of the tumor comes with a higher risk of injury to important surrounding structures in the brain, the researchers noted.

To help resolve the issue, Glantz' team looked at data from 37 previous studies to get a better idea of which surgery might be best. These studies included more than 41,000 glioblastoma patients.

The researchers found that total tumor removal boosted the odds of one-year survival by 61 percent compared to the partial approach. Two-year survival was increased by 19 percent after total removal.

Both total and more moderate surgeries increased one- and two-year survival compared with biopsy alone, the study found.

Overall, the more extensive the surgery, the longer patients survived, according to the study. The researchers also found that people who had their tumor completely removed were more likely to have slower disease progression over one year.

The study was published online June 16 in the journal JAMA Oncology.

The evidence suggests that total removal may be a more effective option than partial removal plus biopsy, Glantz' team said. It also shows that people who are newly diagnosed with this type of brain cancer should have the total removal surgery "when clinically feasible," they added.

Another brain cancer specialist said the findings aren't a big surprise.

"This study confirms what we had thought for a long time -- the superiority of complete surgical removal over partial removal and biopsy," said Dr. John Boockvar. He directs the Brain Tumor Center at Lenox Hill Hospital, in New York City.

For his part, Narayan said brain tumor surgery is an ever-evolving craft that seeks to balance the need for full tumor removal against possible damage to healthy brain tissue.

"Our technology to help with this balancing act is constantly improving, but is by no means perfect yet," he said. "We constantly balance the desire to achieve as complete a removal as possible, with the conflicting priority of trying to give the patient the best quality of life during the time he or she has left."

More information

The American Association of Neurological Surgeons has more on glioblastoma.

Posted: June 2016


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