Practice Patterns for Managing Recurrent Glioblastoma Multiforme

Jitin Bajaj; Shweta Kedia; Arvind Sharma; Pankaj Gupta; Mohammad Ansari; Harsh Deora; Kanwaljeet Garg; Chinmaya Dash; Venkatesh S. Madhugiri; Kuntal Kanti Das; Manjul Tripathi; Deepak K. Singh; Subodh Raju; Anita Jagetia; Vikas Vazhayil; Manmohan Singh; R.S. Mittal; Subhash Gupta; Y.R. Yadav; Altaf Ramzan; Alok Umredkar; Deepak Kumar Jha; A.K. Mahapatra

doi:10.1055/s-0043-1776359

Indian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY 4.0 · Indian Journal of Neurosurgery 2024; 13(01): 059-067
DOI: 10.1055/s-0043-1776359

Original Article

Practice Patterns for Managing Recurrent Glioblastoma Multiforme

Jitin Bajaj

¹Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India

,

Shweta Kedia

²Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

,

Arvind Sharma

³Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India

,

Pankaj Gupta

⁴Department of Neurosurgery, MLN Medical College, Prayagraj, Uttar Pradesh, India

,

Mohammad Ansari

⁵Department of Neurosurgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

,

Harsh Deora

⁶Department of Neurosurgery, NIMHANS, Bangalore, Karnataka, India

,

Kanwaljeet Garg

²Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

,

Chinmaya Dash

⁷Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India

,

Venkatesh S. Madhugiri

⁸Department of Neurosurgery, Roswell Park Comprehensive Cancer Institute, Buffalo, New York, United States

,

Kuntal Kanti Das

⁹Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

,

Manjul Tripathi

¹⁰Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India

,

Deepak K. Singh

¹¹Department of Neurosurgery, Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

,

Subodh Raju

¹²Department of Neurosurgery, AIG Hospitals, Hyderabad, Telangana, India

,

Anita Jagetia

¹³Department of Neurosurgery, GB Pant Hospital, New Delhi, India

,

Vikas Vazhayil

⁶Department of Neurosurgery, NIMHANS, Bangalore, Karnataka, India

,

Manmohan Singh

²Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

,

R.S. Mittal

¹⁴Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

,

Subhash Gupta

¹⁵Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India

,

Y.R. Yadav

¹Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India

,

Altaf Ramzan

¹⁶Department of Neurosurgery, Paras Hospitals, Srinagar, Jammu and Kashmir, India

,

Alok Umredkar

¹⁷Department of Neurosurgery, All India Institute of Medical Sciences, Nagpur, Maharashtra, India

,

Deepak Kumar Jha

¹⁸Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

,

A.K. Mahapatra

⁷Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India

› Institutsangaben

Abstract

Introduction Glioblastoma multiforme (GBM) is a devastating form of cancer with a poor prognosis despite available treatments. Managing recurrent GBM remains challenging and lacks guidelines. This study aims to provide practice patterns for managing recurrent GBMs in India.

Methods A panel of experts was assembled to develop practice patterns using the Delphi technique. Their responses were analyzed anonymously to ensure impartiality and generate recommendations. The statements were intended to be nonbinding and focused on promoting best practices in the field, without legal or regulatory authority.

Results A total of 23 experts participated in the study, providing their opinions on various aspects of managing recurrent GBM. Consensus was achieved on individualized and multidisciplinary management as the preferred approach. Surgery in combination with other treatments was found to impact survival in patients older than 65 years, with re-surgery and adjuvant radiation and chemotherapy being the preferred options. Gadolinium-enhanced magnetic resonance imaging (MRI) brain with spectroscopy and diffusion-weighted imaging was favored. Molecular profiling was considered significant, with O⁶-methylguanine DNA methyltransferase methylation being most relevant. Surgery was recommended for recurrent GBMs, primarily based on Karnofsky's performance score (KPS). Surgical adjuncts such as neuronavigation and intraoperative MRI were considered valuable. Radiation therapy, specifically stereotactic radiosurgery, was recommended for selected cases, while opinions on re-chemotherapy were divided. Palliative care was deemed important.

Conclusion This study presents practice patterns for managing recurrent GBM in India, providing standardized recommendations for practice. By implementing these, clinicians can make informed decisions, leading to improved patient outcomes and reduced variability in the management of recurrent GBM.

Keywords

brain tumor - glioblastoma - glioma - recurrent glioblastoma

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References
1 Witthayanuwat S, Pesee M, Supaadirek C, Supakalin N, Thamronganantasakul K, Krusun S. Survival analysis of glioblastoma multiforme. Asian Pac J Cancer Prev 2018; 19 (09) 2613-2617
2 Batash R, Asna N, Schaffer P, Francis N, Schaffer M. Glioblastoma multiforme, diagnosis and treatment; recent literature review. Curr Med Chem 2017; 24 (27) 3002-3009
3 Ghose A, Lim G, Husain S. Treatment for glioblastoma multiforme: current guidelines and Canadian practice. Curr Oncol 2010; 17 (06) 52-58
4 Loeffler JS, Alexander III E, Hochberg FH. et al. Clinical patterns of failure following stereotactic interstitial irradiation for malignant gliomas. Int J Radiat Oncol Biol Phys 1990; 19 (06) 1455-1462
5 Goenka A, Tiek D, Song X, Huang T, Hu B, Cheng S-Y. The many facets of therapy resistance and tumor recurrence in glioblastoma. Cells 2021; 10 (03) 484
6 Durgin JS, Henderson Jr F, Nasrallah MP. et al. Case report: prolonged survival following EGFRvIII CAR T cell treatment for recurrent glioblastoma. Front Oncol 2021; 11: 669071
7 Liang BC, Thornton Jr AF, Sandler HM, Greenberg HS. Malignant astrocytomas: focal tumor recurrence after focal external beam radiation therapy. J Neurosurg 1991; 75 (04) 559-563
8 Gaspar LE, Fisher BJ, Macdonald DR. et al. Supratentorial malignant glioma: patterns of recurrence and implications for external beam local treatment. Int J Radiat Oncol Biol Phys 1992; 24 (01) 55-57
9 Barbagallo GMV, Jenkinson MD, Brodbelt AR. “Recurrent” glioblastoma multiforme, when should we reoperate?. Br J Neurosurg 2008; 22 (03) 452-455
10 Park JK, Hodges T, Arko L. et al. Scale to predict survival after surgery for recurrent glioblastoma multiforme. J Clin Oncol 2010; 28 (24) 3838-3843
11 Easaw JC, Mason WP, Perry J. et al; Canadian Glioblastoma Recommendations Committee. Canadian recommendations for the treatment of recurrent or progressive glioblastoma multiforme. Curr Oncol 2011; 18 (03) e126-e136
12 Hou LC, Veeravagu A, Hsu AR, Tse VCK. Recurrent glioblastoma multiforme: a review of natural history and management options. Neurosurg Focus 2006; 20 (04) E5
13 Hegi ME, Diserens A-C, Gorlia T. et al. MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 2005; 352 (10) 997-1003
14 Chen X, Zhang M, Gan H. et al. A novel enhancer regulates MGMT expression and promotes temozolomide resistance in glioblastoma. Nat Commun 2018; 9 (01) 2949
15 Prajapati HP, Singh DK. Recurrent glioblastoma in elderly: Options and decision for the treatment. Surg Neurol Int 2022; 13: 397
16 Barker II FG, Chang SM, Gutin PH. et al. Survival and functional status after resection of recurrent glioblastoma multiforme. Neurosurgery 1998; 42 (04) 709-720 , discussion 720–723
17 Sacko O, Benouaich-Amiel A, Brandicourt P. et al. The impact of surgery on the survival of patients with recurrent glioblastoma. Asian J Neurosurg 2021; 16 (01) 1-7
18 Wann A, Tully PA, Barnes EH. et al. Outcomes after second surgery for recurrent glioblastoma: a retrospective case-control study. J Neurooncol 2018; 137 (02) 409-415
19 Ziu M, Goyal S, Olson JJ. Congress of Neurological Surgeons systematic review and evidence-based guidelines update on the role of radiation therapy in the management of progressive and recurrent glioblastoma in adults. J Neurooncol 2022; 158 (02) 255-264
20 Kumar G, DSouza H, Menon N. et al. Safety and efficacy of bevacizumab biosimilar in recurrent/ progressive glioblastoma. Ecancermedicalscience 2021; 15: 1166
21 Prajapati HP, Ansari A. Updates in the management of recurrent glioblastoma multiforme. J Neurol Surg A Cent Eur Neurosurg 2023; 84 (02) 174-187
22 Elzinga G, Wong ET. Resolution of cystic enhancement to add-on tumor treating electric fields for recurrent glioblastoma after incomplete response to bevacizumab. Case Rep Neurol 2014; 6 (01) 109-115
23 Mun EJ, Babiker HM, Weinberg U, Kirson ED, Von Hoff DD. Tumor-treating fields: a fourth modality in cancer treatment. Clin Cancer Res 2018; 24 (02) 266-275