ABSTRACT
Primary glial neoplasms, especially astrocytomas in adults, behave clinically in a malignant fashion due to their infiltrating nature, making them microscopically truly ‘‘unresectable.’’ In spite of this, local recurrence is still the major mode of failure for patients even after intensive local therapies. Most commonly, the recurrence is within 2 cm of the original site in 80% to 90% of cases (1-4). Recurrence distally within the central nervous system or systemically is uncommon. Local therapies, in which open operation for tumor resection plays a major role, have been shown to improve patient survival. Although there is some controversy on the role of debulking surgery for elderly patients with malignant gliomas, a number of retrospective and prospective randomized trials, conducted by the Radiation Therapy Oncology Group, have proven the benefit of surgical resection improving survival for patients with supratentorial malignant gliomas (5-8). Laws et al. (9) in an evaluation of the Glioma Outcomes Project data found that resection instead of biopsy was associated with prolonged survival in patients with grade III and IV gliomas. For low-grade gliomas as well, there is a greater body of literature indicating the survival benefit of more extensive surgical resection (10). In addition, Barker et al. (11) found that age and extent of resection were significantly independent predictors of radiation response in patients with glioblastoma. For recurrent gliomas, the volume of residual disease prior to chemotherapy also seems to have an influence on outcome. Keles et al. (12) found that patients in whom the volume of residual disease was less than 10 cm3 had a six-month progression free survival of 32% compared with 8% and 3% for those with volumes of 10 to 15 cm3 and greater than 15 cm3, respectively. For the pediatric population with malignant gliomas, previous studies have shown that surgical resection has been a very important factor in determining outcome (13,14). Regardless of the measure of resection as either the percentage of the original volume or as the volume of postoperative
residual disease, it is frequently the case that many patients with gliomas live ‘‘better, if not longer’’ after debulking surgery.
