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The Role of Repeat Surgical Resection in the Management of Patients with Recurrent Glioblastoma
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- Author / Creator
- Patel, Mukt N
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The prognosis for patients with recurrent glioblastoma (GBM) is dismal, and the question of whether to offer repeat surgery at the time of recurrence is common. Re-operation in the management of these patients is controversial as there is no randomized evidence of benefit. The first component of this work was to evaluate the quality of the literature that addresses the question of whether repeat surgery for recurrent GBM provides a survival advantage. Multiple recent published systematic reviews were found, and we did not think that repeating another systematic review was necessary. However, all studies included in the systematic reviews were retrospective observational studies, and the answer regarding whether to re-operate remained unknown. All of the included studies suffered from the biases of observational studies, and the best management for recurrent GBM patients was unclear.
Because randomized controlled trials (RCT) are the gold standard to evaluate the effectiveness of an intervention, only an RCT can properly evaluate whether repeat surgical management leads to a meaningful survival advantage for patients with recurrent GBM. However, to justify an RCT, the neurosurgical community should be sufficiently uncertain about how to proceed in the care of these patients. In this second part of this work, we assayed the degree of community agreement regarding the management of patients with recurrent GBM. We performed a systematic review to ensure that such a study had not already been done. An inter-observer variability study was carried out and we found sufficient community uncertainty to justify the conduct of an RCT.
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- Subjects / Keywords
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- Graduation date
- Fall 2021
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- Type of Item
- Thesis
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- Degree
- Master of Science
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- License
- This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.