The Value of a Second Operation in Patients with Glioblastoma Multiforme: is it Medically Justified and Ethically Appropriate?
Received Date: November 08, 2021; Published Date: November 30, 2021
Objective: Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor, having a high incidence of local recurrence.
The question remains if a second operation offers the patient an enough and meaningful longer survival to be medically justified and ethically
appropriate. In this paper we attempt to come up with a reasonable answer through the results in our patients and in similar ones in the literature
Materials and Methods: The records of 49 patients with gross total resection of GBM were reviewed for two groups, comparing 20 patients with symptomatic recurrence, with that of 29 patients having a second operation. Effects of age, inter-operative duration, and adjuvant therapies on survival were studied, using univariate and multivariate analysis. The results were compared with similar studies in the literature.
Results: The results indicate median survival of 34 months (mean 38.9) for one operation, and 27.5 months (mean 49.9) for two operations (p=0.4). Adjuvant therapy, including radiation and chemotherapy with BCNU and Podophyllotoxins, had no significant survival benefit in either group. Patients younger than 60 years had significantly longer survival (median 32 months) compared with older patients (median 19 months, p=0.03). Interoperative interval of more than 2 years had significantly longer survivals. (p=0.02).
Conclusions: This study as with those similar in the literature indicates that patients with histological diagnoses of “glioblastoma” significantly have varied duration of survival; likely caused by difference in the genetic makeup of the tumors, their location, and comorbidity. That creates uncertainty in recommending a second operation. Yet, a second operation can extend survival in months for younger patients, especially for those younger than 40 years. Thus, it should be reasonable both ethically and clinically, if selected based on high ethical standard, patient’s informed consent, and realistic clinical expectation that the extending survival would somehow improve the patient’s medical condition.