Should We Reoperate For Recurrent High-grade Astrocytoma?

Objective Despite optimal treatment of post-operative radiotherapy and chemotherapy for newly diagnosed high grade astrocytoma, nearly all patients eventually recur. However, reoperation is questionable as reported in different institutes. To investigate the therapeutic effect of reoperation on patients with recurrent high-grade astrocytoma more objectively, a retrospective case-matched study was carried out.Methods The clinical data of 63 cases of recurrent high-grade astrocytoma treated between January 2006 and December 2008 were studied.21 cases received reoperation immediately after tumor recurrence were included in this study.42 cases did not receive reoperation were matched by gender, age, Karnofsky Performance Scale (KPS) score, histopathology, recurrent interval after the first operation, extent of initial surgery, adjuvant treatment and characteristics of recurrent tumor.Results The median survival time was 7 months in the group of patients with a second resection. While in patients without reoperation, it was 4 months. The difference was statistically significant on univariate analysis (P<0.001). Moreover, the median duration time of fair condition (defined as the period during which the patient had a KPS score of at least 60) after tumor recurrence was longer in patients who underwent a second resection (5 months) than others (2.5 months) significantly (P<0.001). Reoperation, KPS score and tumor location influence the survival and quality of survival of recurrent high-grade astrocytoma patients.Conclusion The study suggested that, reoperation prolonged the survival time and improved the quality of survival of patients with recurrent high-grade astrocytoma.