Jul 2026· Journal of Paediatric Surgeons of Bangladesh· Vol 17, pp. 73-77· 0 citations· 23 references
TL;DR
Improved survival correlates with gross total resection, thorough chemoradiotherapy, non-midline tumor positioning, and positive MRI characteristics, emphasizing the significance of extensive safe surgery and advanced imaging for predicting outcomes.
Abstract
Background: Glioblastoma (GBM) is the most aggressive primary brain tumor, causing neurological symptoms and requiring MRI-guided surgery followed by radiotherapy and temozolomide. Despite treatment, prognosis remains poor, with a median survival of about 14 months, though outcomes improve with younger age, maximal safe resection, and completion of therapy. Advanced imaging may improve prognostic assessment, but data from low-resource settings remain limited. Methods: A 5-year forward-looking study (2021–2026) at Dhaka Medical College Hospital and Green Life Hospital involved 30 patients with supratentorial glioblastoma who underwent maximal safe resection along with standard chemoradiotherapy. Patients underwent clinical and MRI evaluations, and survival analysis was conducted using the Kaplan–Meier method. Approval from the ethics committee and informed consent were secured Results: Fifteen patients diagnosed with supratentorial glioblastoma (average age 54.2 years) primarily exhibited headaches, seizures, and focal deficits. The majority had frontal tumors, lesions that did not cross the midline, and received gross total resection followed by chemoradiotherapy. The median overall survival time was 16.4 months, and the 5-year survival rate was 20% (6 out of 30). Improved outcomes were linked to gross total resection, tumors located away from the midline, completion of treatment, and positive MRI characteristics Conclusion: Supratentorial glioblastoma has a grim outlook even with combined treatment approaches. Improved survival correlates with gross total resection, thorough chemoradiotherapy, non-midline tumor positioning, and positive MRI characteristics, emphasizing the significance of extensive safe surgery and advanced imaging for predicting outcomes.
Journal of Paediatric Surgeons of Bangladesh (2026) Vol. 17 (1): 73-77
Abstract Background Multicentric glioblastoma (MCG) is a rare and aggressive form of brain parenchymal malignancy, with limited evidence guiding its optimal management. A trimodality treatment approach—comprising surgery, radiotherapy, and chemotherapy—appears to offer better clinical outcomes compared with partial treatment or supportive care alone. Objectives This study aimed to shed light on possible treatment strategies in patients with MCG and their clinical outcomes. Materials and Methods This is a retrospective case series of five patients diagnosed with MCG at our institution between January 2019 and December 2023. Patients were identified through a review of the institutional medical records department. Inclusion criteria were (1) histopathologically confirmed glioblastoma multiforme as per WHO classification, (2) radiological evidence of two or more spatially separate enhancing lesions in different brain regions with no connecting T2/FLAIR hyperintense signal, indicating absence of white matter tract dissemination or parenchymal continuity, consistent with MCG as per criteria, and (3) availability of complete clinical, radiological, and treatment data. All patients underwent pretreatment MRI with contrast, which was independently reviewed by two neuroradiologists. Surgical and oncological management decisions were made in multidisciplinary tumor board meetings. Molecular profiling, including methylguanine methyltransferase (MGMT) promoter methylation status and IDH1/IDH2 mutation status, was performed where available. Data collected included demographics, presenting symptoms, tumor locations, imaging findings, extent of surgical resection, adjuvant therapy, progression-free survival, and overall survival. Results Three patients underwent surgery, one underwent surgical biopsy, and one adult, being the exception—did not undergo any surgical intervention/biopsy. Three adults, except one adult and the pediatric patient, received radiation. All except one adult received temozolomide. The remaining adult patient who did not receive any treatment modality was a case of recurrent glioblastoma with multicentric disease, in a previously known case of solitary glioblastoma treated radically. This patient was kept on best supportive care. All the patients expired. Survival ranged from 3 to 14 months. The longest survivor (14 months) was an adult patient who underwent surgical resection followed by hypofractionated whole brain radiotherapy (30 Gy/10 fractions) and completed six cycles of adjuvant temozolomide. Patients receiving surgery followed by adjuvant therapy survived 11 to 14 months, whereas those receiving limited or no treatment had shorter survival (3–6 months). Conclusion Although outcomes remain poor, patients receiving multimodal therapy appeared to have longer survival, although interpretation is limited by small sample size. Larger studies are required to validate these findings.
Adil Ahmed Khan, Sanjay Sajeevan, Sweety Gupta et al.· Indian Journal of Neurosurge...· 0 citations
Objective. To evaluate the efficacy and safety of combining neoadjuvant stereotactic radiosurgery (SRS) with surgical resection of the dominant brain metastasis in patients with oligometastatic disease (OMD). Material and methods. Forty patients with 2—5 brain metastases meeting ESTRO–EORTC OMD criteria underwent whole-body PET/CT for staging. Neoadjuvant SRS was delivered to the dominant lesion (15—18 Gy, CTV + 1 mm) and to smaller metastases (up to 24 Gy, CTV + 0 mm). Surgical removal of the dominant metastasis followed within 1—3 days after irradiation. Results. Median overall survival reached 12 months, exceeding the 6—9 months typically reported for either surgery or SRS alone. Early postoperative mortality occurred in 5% of patients (brainstem ischemia). No increase in postoperative edema, wound complications, or radiation-induced necrosis was observed. Histological evaluation showed no significant morphological changes after preoperative SRS, supporting the safety of surgery within 24—72 hours post-irradiation. Conclusions. Combining neoadjuvant SRS with surgical resection of the dominant metastasis provides an effective and safe strategy for achieving durable local control in oligometastatic brain disease. This approach shortens the duration of local treatment, facilitates earlier systemic therapy, reduces the risk of leptomeningeal spread and radionecrosis, and may improve overall survival.
A. M. Zaitsev, O. Kirsanova, T. M. Kobyletskaya et al.· P.A. Herzen Journal of Oncol...· 0 citations
BACKGROUND
Glioblastoma multiforme is the commonest primary brain tumor in adults, responsible for 45.2% of primary brain tumors. It is considered a highly aggressive brain tumor with a grave prognosis. Standard treatment for GBM (Glioblastoma Multiforme) consists of maximal safe resection, adjuvant RT (Radiation Therapy), and temozolomide chemotherapy. Despite all the treatments, survival for GBM remains 15-18 months post-diagnosis. Several studies have demonstrated the prognostic significance of different factors, including age, performance status, extent of surgery, and status of molecular markers such as tumor MGMT promoter methylation and IDH mutation. Among the various factors, studies have shown that delaying the start of radiation therapy decreases survival in these patients.
METHODS
This retrospective study was conducted from January 2020 to June 2024 on 47 patients diagnosed with GBM. All these patients underwent surgical resection followed by adjuvant chemoradiation therapy and 6 cycles of maintenance temozolomide. Patient demographics, tumor, and treatment-related details were extracted from retrospectively collected, prospectively curated data. The patients who had been previously treated for a primary brain tumor or for whom pre-RT and follow-up scans were not available were excluded.
RESULTS
The median age at presentation was 45 years. The extent of surgical resection was subtotal in 91.5% of patients. Following surgery, tumor size greater than 4 cm was noted in 63.8% of the patients. The course of adjuvant and maintenance chemoradiation therapy could be completed by 86% of the patients. Among the factors influencing the tumor volume reduction during adjuvant RT, a delay in initiating RT beyond 3 weeks and a residual tumor greater than 4 cm were significantly associated with reduced mean percentage volume change.
CONCLUSIONS
This study provides an important insight into the various prognostic factors affecting the tumor volume reduction rate in GBM patients. We found that greater residual tumor volume following surgery and prolonged interval to RT significantly negatively influenced the rate of tumor volume reduction in GBM patients. Our study strengthens the fact that adjuvant RT should be started as early as possible after surgery. Future studies are warranted to elucidate the impact of the extent of surgical resection and the interval before initiating RT on patient survival.
Himanshu Srivastava, Jasmeet Singh, Preety Negi et al.· Journal of Evolution of Medi...· 0 citations
Abstract Historically, surgical resection was confined to patients with a single brain metastasis (BM). Currently, more effective systemic therapies give improved extracranial disease control, highlighting the need for intracranial symptom and disease control. Therefore, we evaluated outcomes of surgical resection as part of initial local management in patients with multiple BMs. A single center retrospective cohort study was performed. Primary outcome measure was overall survival (OS), the secondary outcome measures were intracranial progression-free survival (iPFS) and extracranial PFS (ePFS). Kaplan-Meier and Cox Proportional Hazards methods were used. Between 1-1-2010 and 31-12-2023, 613 patients underwent BM resection. Of these patients, 131 patients had more than one BM and were included in the study. Median OS was 10.6 months (95% CI: 7.3-14.0 months). Median iPFS was 5.3 months (95% CI: 4.0-6.6 months), median ePFS was 7.5 months (95% CI: 4.2-10.8 months). Patients with melanoma (HR 0.273, 95% CI: 0.110-0.675, p = 0.005), post-surgery stereotactic radiotherapy (HR 0.446, 95% CI: 0.264-0.753, p = 0.002), whole brain radiation therapy (HR 0.598, 95% CI: 0.358-0.997, p = 0.049), systemic treatment (HR 0.370, 95% CI: 0.230-0.595, p < 0.001) or a Karnofsky performance score (KPS) ≥ 70 (HR 0.201, 95% CI: 0.108-0.374, p < 0.001) had a statistically significant lower risk of death from any cause. Age was inversely correlated with mortality (HR 1.023, 95% CI 1.001-1.045, p = 0.036). Of patients with a KPS < 70 (n = 18), only one patient survived more than one year. In conclusion: surgical resection in selected patients with multiple BMs in a good clinical condition provides a meaningful OS and iPFS, possibly by creating a window of opportunity for SRT and systemic therapies.
Micha van der Lee, Miles E Dijkstra, S. Derks et al.· Neuro-Oncology Advances· 0 citations
Background/Objectives: Neurological impairment after glioma resection is a common postoperative event, but many deficits improve during recovery. The present study investigated whether transient and persistent postoperative neurological deficits differ in their association with overall survival (OS) and progression-free survival (PFS). Methods: We retrospectively reviewed data from patients who underwent initial surgical treatment for glioma in our institution. Neurological function was evaluated using documented clinical examinations performed before surgery, in the immediate postoperative period, and during routine follow-up 3–6 months after the procedure. Results: The study cohort comprised 496 patients, of whom 44.4% were women. The mean age at surgery was 60 years (95% CI, 58–61), and the average follow-up period was 21 months (95% CI, 19–23). According to the 2021 WHO classification, 80.0% of tumors were grade 4, 11.1% were grade 3, and 7.3% were grade 2. IDH mutations were absent in 81% of cases. Median survival for the entire cohort was 34 months (95% CI, 30–38). Preoperative neurological deficits, including hemiparesis, were not significantly associated with OS. Postoperative deficits that were resolved by the follow-up assessment showed no relationship with either OS or PFS, irrespective of IDH mutation status. In contrast, neurological deficits that persisted at follow-up were independently associated with shorter OS and PFS among patients with IDH-wild-type gliomas (p < 0.001), whereas no significant association was observed in the IDH-mutant subgroup. Similarly, when new neurological deficits were present at follow-up, poorer OS and PFS were predicted only in patients with IDH-wild-type tumors (p < 0.001). Conclusions: Temporary neurological deterioration following glioma surgery does not appear to adversely influence overall or progression-free survival, regardless of IDH status. However, persistent postoperative deficits, as well as newly acquired deficits that remain evident during follow-up, are strong indicators of an unfavorable prognosis in patients with IDH-wild-type gliomas.
J. Klingenschmid, M. Demetz, N. Pichler et al.· Journal of Clinical Medicine· 0 citations
In this contemporary multicenter cohort of 201 patients, surgical resection of cerebellar metastases achieved a median survival of about one year, and functional status and systemic disease burden remain the strongest predictors of outcome.
T. Araceli, Matthias Demetz, J. Rösler et al.· Neuro-Oncology Advances· 0 citations
