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Surgery for temporal glioblastoma: lobectomy outranks oncosurgical-based gross-total resection

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Abstract

Objective

Supra-total glioblastoma resection has gained growing attention with regard to superior long-term disease control. However, aggressive onco-surgical approaches—geared beyond conventional gross total resections (GTR)—are limited by the impairment of adjacent eloquent areas at risk that may entail severe postoperative functional morbidity. Against this backdrop we analyzed our institutional database with regard to potential survival benefits of anterior temporal lobectomy as a paradigm for supra-total resection in patients with precisely temporal-located, non-eloquent glioblastoma.

Methods

Between 2012 and 2017, 38 patients with isolated temporal glioblastoma underwent GTR or temporal lobectomy at the authors’ institution. Both groups of differing resection modalities were compared with regard to postoperative Karnofsky performance score (KPS), progression-free survival (PFS), and overall survival (OS).

Results

Patients with temporal lobectomy exhibited significantly superior median KPS at the 12 months follow-up compared to the GTR group (median KPS of 80 vs. 60, p = 0.04). Temporal lobectomy was associated with significantly prolonged PFS (p = 0.005) and OS (p = 0.002) coming up to 15 months (95% CI 9.7–22.1) and 23 months (95% CI 14.8–34.5) compared to 7 months (95% CI 3.3–8.3) and 11 months (95% CI 9.2–17.9) for the GTR group. Multivariate analysis revealed temporal lobectomy as the only predictor for both superior PFS (p = 0.037, OR 7.3, 95% CI 1.1–47.4) and OS (p = 0.04, OR 7.8, 95% CI 1.1–55.2).

Conclusions

These results strongly suggest temporal lobectomy as an aggressive supra-total resection policy to constitute the surgical modality of choice for isolated temporal-located glioblastoma.

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Authors and Affiliations

  1. Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Sigmund-Freud-Straße 25, 53127, Bonn, Germany

    Matthias Schneider, Anna-Laura Potthoff, Ági Güresir, Valeri Borger, Motaz Hamed, Hartmut Vatter, Erdem Güresir & Patrick Schuss

  2. Department of Radiology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany

    Vera C. Keil

  3. Division of Clinical Neurooncology, Department of Neurology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany

    Johannes Weller & Ulrich Herrlinger

  4. Department of Neuropathology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany

    Andreas Waha

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  1. Matthias Schneider
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Correspondence to Matthias Schneider.

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The present study was approved by the local ethics committee af the University of Bonn.

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Schneider, M., Potthoff, AL., Keil, V.C. et al. Surgery for temporal glioblastoma: lobectomy outranks oncosurgical-based gross-total resection. J Neurooncol 145, 143–150 (2019). https://doi.org/10.1007/s11060-019-03281-1

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