Repeat brain surgery extends life

New research showing repeat surgery can improve survival and quality of life for brain cancer patients is expected to spark wide debate following its presentation on 19 November at a national cancer conference.

Sydney neurosurgeon Dr Charlie Teo, said the research, presented at the Clinical Oncological Society of Australia (COSA) Annual Scientific Meeting, challenged conventional wisdom that additional surgery offered no survival benefit and could impact negatively on quality of life.

"Up until a few years ago, there was no rationale to do repeat surgery because pretty much every patient would die as quickly or more quickly than if they didn't have the extra surgery, sometimes on the operating table," Dr Teo said.

"However, keyhole surgery has advanced rapidly in recent years and this latest study clearly demonstrates that we can extend survival for most patients and achieve improved quality of life."

Dr Teo said the restrospective study looked at 96 patients who had previously been operated on for the most common form of brain cancer and then underwent repeat surgery.

The study found functional status was stable or improved in 68% of cases and that the procedure was safe – all patients survived with low rates of complication (14%) and temporary deficit (34%).

Dr Teo said the research added to a growing evidence base that repeat surgery and aggressive keyhole surgery generally should be recommended for a significant number of patients who currently were not given the option.

"This research will challenge standard practice," he said. "The question is whether clinicians are prepared to look at it seriously and give their patients who could benefit the choice."

Chair of the COSA's Brain Guidelines Group, Professor Michael Barton, said there was good evidence that repeat surgery with intra-cranial chemotherapy improved survival.

"We know this type of surgery is effective, however neurosurgeons have yet to adopt it," he said.

(Source: Clinical Oncological Society of Australia: Clinical Oncological Society of Australia Annual Scientific Meeting, Gold Coast: November 2009)