Re-resection at first recurrence is associated with prolonged survival in young patients with high-grade glioma: A multi-center study

Abstract

Abstract Background Surgical resection remains standard of care for high-grade glioma. It is unclear, however, whether re-resection at the time of first recurrence confers further survival benefit in young patients. Methods This multi-center, retrospective cohort study included patients age 0-21 years with supratentorial high-grade glioma who underwent gross total or near total resection at time of initial diagnosis which subsequently recurred. Patients were grouped by therapeutic re-resection at first recurrence. Post-recurrence overall survival was assessed with Kaplan-Meier methods, multivariable Cox regression, and propensity score-matched analyses. Results Forty-four patients with a median age of 12.5 years from 7 institutions were included. 61% (n = 27) underwent re-resection and 39% (n = 17) did not. The 2 groups (re-resection and no re-resection) did not significantly differ in sex, age at recurrence, functional status, pathology, chemotherapy and radiation exposure, or institution (all P > .05). Kaplan-Meier analysis demonstrated significantly longer post-recurrence overall survival with re-resection compared with no re-resection (median 24.6 vs 8.5 months; log-rank P = .0001). Patients who underwent re-resection had a 73% lower hazard of death after recurrence compared with patients who did not undergo re-resection by multivariable Cox regression (HR 0.27, 95% CI, 0.10-0.69; P = .006) or by propensity score matching analyses (HR 0.27, 95% CI, 0.11-0.68; P = .005). Conclusions Therapeutic re-resection at first recurrence was associated with improved post-recurrence survival, which remained significant after multivariable adjustment or propensity score matching. This study provides evidence for re-resection in recurrent high-grade glioma in young patients.