Surgery of high grade gliomas - pros in favor of maximal cytoreductive surgery

Background: Malignant glioma is the most common primary brain tumour in adults. More and more studies are focused on the role of surgery in prolonged median of survival and survival at two years. The purpose of this study is to add some arguments in favour of radical surgery in malignant glioma. Material and Methods: The study is based 433 cases of high grade cerebral glioma operated between 01.01.2000-31.12.2009 at the Department of Neurosurgery, Cluj County Emergency Hospital. We analyzed age, gender, type and duration of symptoms, type of surgery, pathological diagnosis and the correlation of these factors with overall survival. Data for long term follow up were available for 266 patients. Results: The results shows, according to their histological features, the fallowing dispersions: astrocitomas grade III (28%), glioblastoma multiforme (64%), high grade oligodendrogliomas (5%) and high grade ependimomas (3%). The global survival rate was 47 % at 12 months, 26,3% at 18 months and 16,7% at 24 months. The age and type of surgery are prognostic factors that significantly influenced the survival at 12, 18 and 24 months (9,3 months age <65 years versus 7,1 months age >65 years; 9,2 months GTR versus 6,4 months STR-at 12 months monitoring; 11,7 months age <65 versus 7,7 months age >65; 11,5 months GTR versus 7,1 months STR-at 18 months monitoring; 12,8 months age <65 versus 8 months age >65; 12,6 months GTR versus 7,5 months STR –at 24 months monitoring). Conclusions: Our study shows that long term postoperative outcome after radical surgical resection are better than the results of either partial resection or simple biopsy; in terms of duration of survival (the difference of mean survival at 12, 18 and 24 months monitoring was 2,8 months, 4,4 months and 5,1 months respectively in favour of patients with gross total removal) .