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

November 1, 2012, Johns Hopkins University School of Medicine

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.

Explore further: Research yields new clues to how brain cancer cells migrate and invade

Related Stories

Research yields new clues to how brain cancer cells migrate and invade

May 1, 2012
Researchers have discovered that a protein that transports sodium, potassium and chloride may hold clues to how glioblastoma, the most common and deadliest type of brain cancer, moves and invades nearby healthy brain tissue. ...

New 'scarless' surgery takes out tumors through natural skull opening

October 26, 2011
A technique developed by Johns Hopkins surgeons is providing a new route to get to and remove tumors buried at the base of the skull: through the natural hole behind the molars, above the jawbone and beneath the cheekbone.

Recommended for you

Antibodies may predict transplant rejection risk

June 19, 2018
The presence of certain antibodies in patients may suggest a higher risk of transplant rejection across multiple organ types, including the kidney, liver, heart and lungs, according to a new study published in PLOS Medicine.

Surgical blood transfusions tied to clot risk

June 13, 2018
(HealthDay)—Blood transfusions around the time of surgery may raise your risk for dangerous blood clots, researchers say.

Tonsil and adenoid removal associated with respiratory, allergic and infectious disease

June 7, 2018
Tonsil and adenoid removal associated with long-term risks of respiratory, allergic and infectious diseases Removing tonsils and adenoids in childhood increases the long-term risk of respiratory, allergic and infectious diseases, ...

Clues found to early lung transplant failure

May 21, 2018
Among organ transplant patients, those receiving new lungs face a higher rate of organ failure and death compared with people undergoing heart, kidney and liver transplants. One of the culprits is inflammation that damages ...

In breakthrough, surgeon builds windpipes from arteries

May 20, 2018
Where others failed, sometimes spectacularly, French surgeon Emmanuel Martinod has helped people whose windpipes have been ravaged by cancer and other diseases to live and breathe normally again.

Blood type O patients may have higher risk of death from severe trauma

May 1, 2018
Blood type O is associated with high death rates in severe trauma patients, according to a study published in the open access journal Critical Care that involved 901 Japanese emergency care patients.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.