Repeated surgeries appear to extend life of patients with deadliest of brain cancers

People who undergo repeated surgeries to remove glioblastomas—the most aggressive and deadliest type of brain tumors—may survive longer than those who have just a one-time operation, new Johns Hopkins research suggests.

Glioblastoma, the that killed Sen. Edward Kennedy, inevitably returns after tumor-removal surgery, chemotherapy, and/or radiation. The median survival time after diagnosis is only 14 months. With recurrence a near certainty, experts say, many have questioned the value of performing second, third or even fourth operations, especially given the dangers of , including the risk of or death.

"We are reluctant to operate on with brain cancer multiple times as we are afraid to incur new neurological deficits or poor wound healing, and many times we are pessimistic about the survival chances of these patients," says Alfredo Quinones-Hinojosa, M.D., a professor of neurosurgery at the Johns Hopkins University School of Medicine and leader of the study published recently in the . "But this study tells us that the more we operate, the longer they may survive. We should not give up on these patients."

For the study, Quinones-Hinojosa and his team reviewed the records of 578 patients who underwent surgery to remove a glioblastoma between 1997 and 2007 at The Johns Hopkins Hospital. At the last follow-up, 354 patients had one surgery, 168 had two resections, and 41 and 15 patients had three and four operations, respectively. The median survival for patients who underwent one, two, three and four operations was 6.8 months, 15.5 months, 22.4 months and 26.6 months, respectively.

Quinones-Hinojosa cautions that his analysis may overestimate the value of multiple surgeries based on patient selection, and that it's possible that the patients who did better had tumors with a biology that predisposed them to live longer. Further research will need to confirm his more positive conclusion.

Glioblastomas are cancerous tumors that become deeply intertwined with healthy tissue and, as a result, are difficult to remove. They are notoriously difficult to eradicate with surgery alone. "The only thing that has been proven to work for glioblastoma throughout history is surgery," Quinones-Hinojosa says. "Without surgery, these patients don't have much of a chance."

Along with reducing the size of tumors, repeated surgeries may also increase the efficacy of radiation and chemotherapy.

Quinones-Hinojosa says with each successive surgery, the procedure itself becomes more technically challenging as the anatomy changes, blood vessels are damaged and tissues become frail.

Patients, their families and their doctors must determine whether repeated is the best course of action, weighing the potential risks against the potential benefits, Quinones-Hinojosa says. The procedure should only be done if it can be done relatively safely and patients can tolerate anesthesia and the long recovery period.

add to favorites email to friend print save as pdf

Related Stories

Just add water and treat brain cancer

Jul 06, 2011

Researchers at the Johns Hopkins University School of Medicine have developed a technique that delivers gene therapy into human brain cancer cells using nanoparticles that can be freeze-dried and stored for up to three months ...

Recommended for you

Breakthrough could prevent hip implant replacement

8 hours ago

Hip implants rely on the normal functioning of bone cells to achieve fixation of the implant with the bone. However, small metal particles released from hip implants, due to friction between the moving surfaces, ...

Ultrasound can accurately diagnose carpal tunnel

12 hours ago

(HealthDay)—Ultrasound can accurately confirm the diagnosis of carpal tunnel syndrome, according to a study published in the Sept. 3 issue of The Journal of Bone & Joint Surgery.

User comments