Survival and functional status after resection of recurrent XXXX .

@entity1 @entity463 @entity5 @entity797
OBJECTIVE: To determine the selection factors for and results of second resections performed to treat recurrent @entity463 ( @entity463 ), we studied 301 @entity1 with @entity463 who were treated from the time of diagnosis using two prospective clinical protocols. METHODS: The @entity1 were prospectively followed from the time of diagnosis, using clinical and radiographic criteria after maximal surgical resection and external beam radiotherapy with or without adjuvant chemotherapy. Resection of recurrent @entity463 was performed at the recommendation of the treating clinicians. The results of the second resections were retrospectively reviewed and analyzed using multivariate logistic regression, Kaplan-Meier-Turnbull survival analysis, @entity797 regression, and propensity score stratification. RESULTS: Forty-six @entity1 underwent second resections during the study period. The actuarial rate of the second resections was 15% of the @entity1 1 year after diagnosis and 31% 2 years after diagnosis. Younger age (P = 0.01) and more extensive initial resection (P = 0.02), but not Karnofsky Performance Scale (KPS) score at the time of diagnosis or recurrence, predicted a higher chance of selection for reoperation after initial @entity5 recurrence. Twenty-eight percent of the @entity1 had improved KPS scores after undergoing reoperation, 49% were stable, and 23% had declines in KPS scores of 10 to 30 points. There was no operative mortality. After reoperation, 85% of the @entity1 received chemotherapy, 11% received brachytherapy or underwent stereotactic radiosurgery, and 17% underwent third resections. The median survival period after reoperation was 36 weeks. Higher preoperative KPS scores predicted longer survival periods after reoperation (P = 0.03). Age and interval since diagnosis were not significant prognostic factors. The median high-quality survival period (KPS score, > or =70) was 18 weeks. The median survival period after first @entity5 progression was 23 weeks for 130 @entity1 treated using the same protocols who did not undergo reoperations. @entity1 who did undergo reoperations experienced clinically and statistically significantly longer survival periods. However, this was determined to be partially because of selection bias. CONCLUSION: Survival after resection of recurrent @entity463 remains poor despite advances in imaging, operative technique, and adjuvant therapies. High-quality survival after resection of recurrence to treat @entity463 seems to have increased significantly since an earlier report from our institution.
