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CC BY 4.0 · Indian Journal of Neurosurgery 2024; 13(01): 059-067
DOI: 10.1055/s-0043-1776359
Original Article

Practice Patterns for Managing Recurrent Glioblastoma Multiforme

Jitin Bajaj 
1   Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
,
Shweta Kedia
2   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Arvind Sharma 
3   Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
,
Pankaj Gupta
4   Department of Neurosurgery, MLN Medical College, Prayagraj, Uttar Pradesh, India
,
Mohammad Ansari
5   Department of Neurosurgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
,
Harsh Deora 
6   Department of Neurosurgery, NIMHANS, Bangalore, Karnataka, India
,
Kanwaljeet Garg
2   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Chinmaya Dash
7   Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
,
Venkatesh S. Madhugiri
8   Department of Neurosurgery, Roswell Park Comprehensive Cancer Institute, Buffalo, New York, United States
,
Kuntal Kanti Das
9   Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Manjul Tripathi 
10   Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Deepak K. Singh
11   Department of Neurosurgery, Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Subodh Raju
12   Department of Neurosurgery, AIG Hospitals, Hyderabad, Telangana, India
,
Anita Jagetia
13   Department of Neurosurgery, GB Pant Hospital, New Delhi, India
,
Vikas Vazhayil 
6   Department of Neurosurgery, NIMHANS, Bangalore, Karnataka, India
,
Manmohan Singh
2   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
R.S. Mittal
14   Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Subhash Gupta
15   Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
,
Y.R. Yadav 
1   Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
,
Altaf Ramzan
16   Department of Neurosurgery, Paras Hospitals, Srinagar, Jammu and Kashmir, India
,
Alok Umredkar
17   Department of Neurosurgery, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
,
Deepak Kumar Jha 
18   Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
A.K. Mahapatra
7   Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
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Abstract

Introduction Glioblastoma multiforme (GBM) is a devastating form of cancer with a poor prognosis despite available treatments. Managing recurrent GBM remains challenging and lacks guidelines. This study aims to provide practice patterns for managing recurrent GBMs in India.

Methods A panel of experts was assembled to develop practice patterns using the Delphi technique. Their responses were analyzed anonymously to ensure impartiality and generate recommendations. The statements were intended to be nonbinding and focused on promoting best practices in the field, without legal or regulatory authority.

Results A total of 23 experts participated in the study, providing their opinions on various aspects of managing recurrent GBM. Consensus was achieved on individualized and multidisciplinary management as the preferred approach. Surgery in combination with other treatments was found to impact survival in patients older than 65 years, with re-surgery and adjuvant radiation and chemotherapy being the preferred options. Gadolinium-enhanced magnetic resonance imaging (MRI) brain with spectroscopy and diffusion-weighted imaging was favored. Molecular profiling was considered significant, with O6-methylguanine DNA methyltransferase methylation being most relevant. Surgery was recommended for recurrent GBMs, primarily based on Karnofsky's performance score (KPS). Surgical adjuncts such as neuronavigation and intraoperative MRI were considered valuable. Radiation therapy, specifically stereotactic radiosurgery, was recommended for selected cases, while opinions on re-chemotherapy were divided. Palliative care was deemed important.

Conclusion This study presents practice patterns for managing recurrent GBM in India, providing standardized recommendations for practice. By implementing these, clinicians can make informed decisions, leading to improved patient outcomes and reduced variability in the management of recurrent GBM.

Keywords

brain tumor - glioblastoma - glioma - recurrent glioblastoma


Publication History

Article published online:
29 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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