Glioblastoma Management: Lobectomy Shows Promise, Improves Survival Outcomes

Lobectomy vs gross total resection for the management of glioblastoma is associated with improved survival outcomes, according study results published in Brain and Spine.

Researchers conducted a systematic review and meta-analysis to compare the overall survival and progression-free survival (PFS) associated with lobectomy vs other management strategies for glioblastoma. Databases were searched for comparative studies on lobectomy in managing patients with glioblastoma between January 2013 and April 2023. Studies published in English with original data comparisons between lobectomy and other surgical alternatives for the management of glioblastoma in more than 5 adult patients were eligible for inclusion. Outcomes of interest included overall survival, PFS, performance status, seizure control, and complications following glioma surgery. Odds ratios (ORs), hazard rates (HRs), and mean differences were calculated.

A total of 6 studies were included in the evidence synthesis, all of which were published between 2016 and 2021. Three studies were conducted in Germany, 1 in the US, 1 in Korea, and 1 in Egypt. The sample sizes ranged between 33 and 69 patients and the average patient age ranged from 48 to 68.

In all studies, lobectomy was compared with gross total resection; however, in 1 study, an additional 2 arms were included (subtotal resection and biopsy). Qualitative data was provided on overall survival (n=4),PFS (n=3), Karnofsky Performance Score (KPS; n=3), seizure control (n=2), operation duration (n=1), and length of hospital stay (n=1). The narrative review included an additional 2 studies.

Mean overall survival was highest with lobectomy (25 months; 95% CI, 15.43-34.57), followed by gross total resection (13.72; 95% CI, 10.36-17.08), subtotal resection (7.30; 95% CI, 5.79-8.81), and biopsy (4.70; 95% CI, 3.4-6.0). After excluding 1 study, mean overall survival remained longer in lobectomy (30.33; 95% CI, 17.74-42.92) vs gross total resection (14.63; 95% CI, 9.51-19.75).

Similarly, mean PFS was more improved with lobectomy (16.13; 95% CI, 10.84-21.42) vs gross total resection (8.77; 95% CI, 6.41-11.13). The mean difference between the 2 treatment modalities was estimated to be 8.77 months (95% CI, 3.17-14.38), favoring lobectomy.

In the 3 studies that reported on postoperative performance status, 2 reported similar functional status scores among patients undergoing lobectomy vs gross total resection (mean KPS, 80), while the third study reported superior mean KPS at 12 months among patients who underwent lobectomy vs gross total resection (80 vs 60, respectively; P =.04).

Conflicting results were reported for seizure control outcomes. One study reported that lobectomy vs gross total resection was more effective (OR, 27; 95% CI, 1.4-515.9), while a second study found no difference in the seizure control rate among the same 2 groups (2.7% vs 3.1%, respectively; P =1.00).

According to 1 study that assessed operation time, there was no between-group difference for lobectomy vs gross total resection (mean, 270 vs 268 minutes; P =.9).

Similarly, in the 1 study that evaluated hospital stay, no significant differences were observed between the lobectomy and gross total resection groups (mean, 14 vs 15 days, respectively; P =.6).

The 2 studies that reported on surgical complications found no significant difference in risk between lobectomy and gross total resection.

Study limitations include the low number of included studies, small sample sizes, and low quality evidence, use of noncomparable data, and potential publication bias.

“Lobectomy, while demanding from a technical standpoint, constitutes a safe surgical procedure but further studies should assess its exact role in the management of GB patients,” the study authors concluded.