Background: Glioblastoma (GBM) patients exhibit a median overall survival of 12–18 months post-diagnosis, with disease recurrence typically emerging within 6–9 months. Due to the absence of standardized therapeutic protocols at recurrence, management is highly individualized. This study comprehensively evaluates overall survival (OS) time to subsequent progression, and clinical status evolution following diverse interventions for first GBM recurrence. Methods: Data from 350 patients were retrospectively analyzed. The entire cohort was divided into the following four groups: (A) patients with no further therapy at recurrence, (B) combined re-radiation and chemotherapy with temozolomide with or without lomustine or other individual medication, (C) surgery without re-adjuvant treatment, and (D) surgery and at least one cycle of chemotherapy or re-radiation or a combination. Statistical analyses were performed using non-parametric tests. Additionally, various regression analyses were performed. Results: Patients receiving invasive therapeutic regimens with or without adjuvant re-therapy (groups C and D) demonstrated significantly prolonged OS (p < 0.001) alongside superior Karnofsky performance status (KPS) at both 3-month (p = 0.016) and 6-month (p < 0.001) intervals post-intervention. Multivariate analysis confirmed surgical resection, temozolomide (TMZ) chemotherapy, and radiotherapy as independent positive predictors of OS (respective p-values: <0.001, <0.001, and 0.048). Notably, surgical resection significantly improved clinical status (p < 0.001), whereas radiotherapy had a significant negative effect on clinical status (p = 0.016). Conclusions: Contrary to the prevailing hypothesis that survival extension through extensive therapy at recurrence necessitates compromised clinical status, our findings demonstrate that contemporary recurrence therapies—particularly multimodal approaches—simultaneously enhance both OS and functional outcomes in GBM patients. This paradigm challenges conventional expectations of therapeutic trade-offs at disease recurrence.
Rapp et al. (Wed,) studied this question.