OBJECTIVE: The best results in glioblastoma (GBM) are obtained through aggressive treatment comprising maximally radical but safe resection followed by chemoradiotherapy. However, certain patients will undergo only stereotactic biopsy. This paper aims to evaluate life expectancy in GBM patients who underwent only stereotactic biopsy, including the effect of subsequent oncological treatment. PATIENTS AND METHODS: Patients with confirmed GBM histology who had undergone stereotactic biopsy between June 2006 and December 2016 were retrospectively selected. Each patient had received a CT scan, followed by an MRI scan with a contrast agent. None of the patients were amenable to microsurgical resection. RESULTS: Of the 60 patients, 41 (69%) received no subsequent oncological treatment, while 14 (23%) underwent isolated radiotherapy. Mean survival time of all patients was 2.8 months. Those who received no additional treatment had an average survival time of 2.3 months; patients who received any type of oncological treatment was 3.7 months. Of these, those receiving radiotherapy alone had a mean survival of 3.1 months. Patients who received oncological treatment with the Stupp protocol had a survival time of 6.6 months. CONCLUSION: Diagnostic and surgical advances related to GBM treatment mean that radical resections can be performed even in eloquent brain areas. However, patients not indicated for resection will experience a major reduction in life expectancy. Patients who underwent stereotactic biopsy and received some form of oncological treatment experienced slightly increased overall survival relative to patients with a natural disease course. Patients with favorable clinical factors reacted better to treatment.

Department of Health Care Sciences Faculty of Humanities Tomas Bata University Zlin Czech Republic

Department of Neurosurgery University Hospital Olomouc and Faculty of Medicine and Dentistry Palacky University Olomouc Olomouc Czech Republic

Department of Oncology University Hospital Olomouc and Faculty of Medicine and Dentistry Palacky University Olomouc Olomouc Czech Republic

Department of Pathology and Laboratory of Molecular Pathology University Hospital Olomouc and Faculty of Medicine and Dentistry Palacky University Olomouc Olomouc Czech Republic

Institute of Molecular and Translational Medicine Faculty of Medicine and Dentistry Palacky University Olomouc Olomouc Czech Republic

Zobrazit více v PubMed

Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, Ohgaki H, Wiestler OD, Kleihues P, Ellison DW. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol 2016;131(6):803-20. doi: 10.1007/s00401-016-1545-1 PubMed DOI

Louis DN, Perry A, Wesseling P, Brat DJ, Cree IA, Figarella-Branger D, Hawkins C, Ng HK, Pfister SM, Reifenberger G, Soffietti R, von Deimling A, Ellison DW. The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol 2021;23(8):1231-51. doi: 10.1093/neuonc/noab106 PubMed DOI

Di L, Heath RN, Shah AH, Sanjurjo AD, Eichberg DG, Luther EM, de la Fuente MI, Komotar RJ, Ivan ME. Resection versus biopsy in the treatment of multifocal glioblastoma: a weighted survival analysis. J Neurooncol 2020;148(1):155-64. doi: 10.1007/s11060-020-03508-6 PubMed DOI

Shah AH, Mahavadi A, Di L, Sanjurjo A, Eichberg DG, Borowy V, Figueroa J, Luther E, de la Fuente MI, Semonche A, Ivan ME, Komotar RJ. Survival benefit of lobectomy for glioblastoma: moving towards radical supramaximal resection. J Neurooncol 2020;148(3):501-8. doi: 10.1007/s11060-020-03541-5 PubMed DOI

Hamisch CA, Minartz J, Blau T, Hafkemeyer V, Rueß D, Hellerbach A, Grau SJ, Ruge MI. Frame-based stereotactic biopsy of deep-seated and midline structures in 511 procedures: feasibility, risk profile, and diagnostic yield. Acta Neurochir 2019;161(10):2065-71. doi: 10.1007/s00701-019-04020-1 PubMed DOI

Callovini GM, Telera S, Sherkat S, Sperduti I, Callovini T, Carapella CM. How is stereotactic brain biopsy evolving? A multicentric analysis of a series of 421 cases treated in Rome over the last sixteen years. Clin Neurol Neurosurg 2018;174:101-7. doi: 10.1016/j.clineuro.2018.09.020 PubMed DOI

Sciortino T, Fernandes B, Conti Nibali M, Gay LG, Rossi M, Lopci E, Colombo AE, Elefante MG, Pessina F, Bello L, Riva M. Frameless stereotactic biopsy for precision neurosurgery: diagnostic value, safety, and accuracy. Acta Neurochir 2019;161(5):967-74. doi: 10.1007/s00701-019-03873-w PubMed DOI

Albert NL, Weller M, Suchorska B, Galldiks N, Soffietti R, Kim MM, la Fougère C, Pope W, Law I, Arbizu J, Chamberlain MC, Vogelbaum M, Ellingson BM, Tonn JC. Response Assessment in Neuro-Oncology working group and European Association for Neuro-Oncology recommendations for the clinical use of PET imaging in gliomas. Neuro Oncol 2016;18(9):1199-208. doi: 10.1093/neuonc/now058 PubMed DOI

Lobão CA, Nogueira J, Souto AA, Oliveira JA. Cerebral biopsy: comparison between frame-based stereotaxy and neuronavigation in an oncology center. Arq Neuropsiquiatr 2009;67(3B):876-81. doi: 10.1590/s0004-282x2009000500018 PubMed DOI

Bradac O, Steklacova A, Nebrenska K, Vrana J, de Lacy P, Benes V. Accuracy of VarioGuide frameless stereotactic system against frame-based stereotaxy: prospective, randomized, single-center study. World Neurosurg 2017;104:831-40. doi: 10.1016/j.wneu.2017.04.104 PubMed DOI

Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, Ludwin SK, Allgeier A, Fisher B, Belanger K, Hau P, Brandes AA, Gijtenbeek J, Marosi C, Vecht CJ, Mokhtari K, Wesseling P, Villa S, Eisenhauer E, Gorlia T, Weller M, Lacombe D, Cairncross JG, Mirimanoff RO, European Organisation for Research and Treatment of Cancer Brain Tumour and Radiation Oncology Groups, National Cancer Institute of Canada Clinical Trials Group. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 2009;10(5):459-66. doi: 10.1016/S1470-2045(09)70025-7 PubMed DOI

Matsui JK, Perlow HK, Facer BD, McCalla A, Marrazzo L, Detti B, Scorsetti M, Clerici E, Scoccianti S, Navarria P, Trifiletti DM, Gondi V, Bovi J, Huang J, Brown PD, Palmer JD. Radiotherapy for elderly patients with glioblastoma: an assessment of hypofractionation and modern treatment techniques. Chin Clin Oncol 2022;11(5):38. doi: 10.21037/cco-22-76 PubMed DOI

Asmaa A, Dixit S, Rowland-Hill C, Achawal S, Rajaraman C, O'Reilly G, Highley R, Hussain M, Baker L, Gill L, Morris H, Hingorani M. Management of elderly patients with glioblastoma-multiforme-a systematic review. Br J Radiol 2018;91(1088):20170271. doi: 10.1259/bjr.20170271 PubMed DOI

Weller M, van den Bent M, Preusser M, Le Rhun E, Tonn JC, Minniti G, Bendszus M, Balana C, Chinot O, Dirven L, French P, Hegi ME, Jakola AS, Platten M, Roth P, Rudà R, Short S, Smits M, Taphoorn MJB, von Deimling A, Westphal M, Soffietti R, Reifenberger G, Wick W. EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol 2021;18(3):170-86. doi: 10.1038/s41571-020-00447-z. Erratum in: Nat Rev Clin Oncol 2022;19(5):357-8. PubMed DOI

Chaichana KL, Garzon-Muvdi T, Parker S, Weingart JD, Olivi A, Bennett R, Brem H, Quiñones-Hinojosa A. Supratentorial glioblastoma multiforme: the role of surgical resection versus biopsy among older patients. Ann Surg Oncol 2011;18(1):239-45. doi: 10.1245/s10434-010-1242-6 PubMed DOI

Gallet C, Clavreul A, Morandi X, Delion M, Madec N, Menei P, Lemée JM. What surgical approach for left-sided eloquent glioblastoma: biopsy, resection under general anesthesia or awake craniotomy? J Neurooncol 2022;160(2):445-54. doi: 10.1007/s11060-022-04163-9 PubMed DOI

Vuorinen V, Hinkka S, Färkkilä M, Jääskeläinen J. Debulking or biopsy of malignant glioma in elderly people - a randomised study. Acta Neurochir 2003;145(1):5-10. doi: 10.1007/s00701-002-1030-6 PubMed DOI

Hirschler L, Sollmann N, Schmitz-Abecassis B, Pinto J, Arzanforoosh F, Barkhof F, Booth T, Calvo-Imirizaldu M, Cassia G, Chmelik M, Clement P, Ercan E, Fernández-Seara MA, Furtner J, Fuster-Garcia E, Grech-Sollars M, Guven NT, Hatay GH, Karami G, Keil VC, Kim M, Koekkoek JAF, Kukran S, Mancini L, Nechifor RE, Özcan A, Ozturk-Isik E, Piskin S, Schmainda K, Svensson SF, Tseng CH, Unnikrishnan S, Vos F, Warnert E, Zhao MY, Jancalek R, Nunes T, Emblem KE, Smits M, Petr J, Hangel G. Advanced MR Techniques for Preoperative Glioma Characterization: Part 1. Magn Reson Imaging 2023;57(6):1655-75. doi: 10.1002/jmri.28662 PubMed DOI

Hangel G, Schmitz-Abecassis B, Sollmann N, Pinto J, Arzanforoosh F, Barkhof F, Booth T, Calvo-Imirizaldu M, Cassia G, Chmelik M, Clement P, Ercan E, Fernández-Seara MA, Furtner J, Fuster-Garcia E, Grech-Sollars M, Guven NT, Hatay GH, Karami G, Keil VC, Kim M, Koekkoek JAF, Kukran S, Mancini L, Nechifor RE, Özcan A, Ozturk-Isik E, Piskin S, Schmainda KM, Svensson SF, Tseng CH, Unnikrishnan S, Vos F, Warnert E, Zhao MY, Jancalek R, Nunes T, Hirschler L, Smits M, Petr J, Emblem KE. Advanced MR Techniques for Preoperative Glioma Characterization: Part 2. J Magn Reson Imaging 2023;57(6):1676-95. doi: 10.1002/jmri.28663 PubMed DOI