Surgical management of newly diagnosed glioblastoma in adults: role of cytoreductive surgery

Thirty papers are included in the attached Evidentiary Table 1. These include 10 prospective studies and twenty retrospective studies. Five of the prospective studies provided Class II data [ 10, 12, 16, 19, 20] and one of the 20 retrospective studies provided Class II data [ 14]. All but one of these better quality studies support extent of resection as a factor in improving survival in newly diagnosed adult patients with malignant glioma. Of these only the study of Levin published in 1985 failed to support extent of resection for glioblastoma, but did demonstrate a survival advantage in cases of anaplastic astrocytoma. Of the remaining retrospective papers reviewed, all provided Class III data. Fourteen of the nineteen provided data that supported the concept of cytoreductive surgery in the initial management of malignant glioma. As a result, it follows that the majority of the reviewed data supports maximal cytoreductive surgery. In addition it is clear that rigorous postoperative imaging and analysis of residual tumor burden is best done by an independent analyst and that it is indicative of increased survival. Quality of life continues is an important pre and postoperative consideration and appears to be maintained for longer periods of time in the setting of a maximal debulking operation.