Postoperative Surveillance Does Not Improve Survival in Deadly Brain Cancer

By Kaitlyn D’Onofrio - Last Updated: February 26, 2020

According to a new study, patients with high-grade glioma (HGG) who undergo routine surveillance do not have better survival outcomes compared to HGG patients who return to the doctor when they feel symptomatic.

“Standard follow-up care for patients with high-grade glioma (HGG) involves routine surveillance imaging to detect disease progression, assess treatment response, and monitor clinical symptoms. Although logical in nature, evidence supporting this practice is limited,” the study authors wrote.

Glioblastoma is an aggressive, often fatal, cancer that begins in the brain. Survival rates have improved over time, but many patients experience tumor recurrence. To that end, regular surveillance would presumably be a best practice to catch a new tumor early.

However, according to study author N. Scott Litofsky, MD, professor and chief of neurological surgery at the MU School of Medicine and MU Health Care, “Patients who undergo regular imaging can become nervous or anxious in the days or weeks leading up to their imaging appointment.”

To assess the value of surveillance, Dr. Litofsky and colleagues retrospectively reviewed adult patients at their institution treated for HGG between 2004 and 2018. Data collection included tumor characteristics, imaging results, neurologic status, and survival. Patients were followed for at least one year or survival duration.

The study was published in World Neurosurgery.

Final analysis included 74 patients who experienced recurrence, of whom 47 (63.5%) were diagnosed after routine surveillance imaging and 27 (36.5%) experienced symptoms outside of routine surveillance. Medial overall survival did not significantly differ between the surveillance and symptomatic groups (14.8 months vs. 15.7 months; P=0.600); postrecurrence neurologic function measured per the Karnofsky Performance Scale Index (P=0.699) and Eastern Cooperative Oncology Group (P=0.908) also did not largely differ.

The outcomes suggested that routine imaging, when considering the stress it entails for the patient, may not be the number one option: “While surveillance is good, maybe we can change our protocols to make patients more comfortable and give them more control of the process but still deliver quality care,” said Dr. Litofsky in a press release.

In addition to the anxiety associated with upcoming imaging appointments, access to care may also be a barrier or create stress.

“We have a lot of patients who come from a long distance, and our general philosophy of care is to provide regular follow-up visits,” said Dr. Litofsky. “The hypothesis was patients would do better if we did regular surveillance. The results indicated that for this population of patients, the outcome was equivalent whether they had surveillance or showed up when they had symptoms.”

Looking ahead, Dr. Litofsky suggested that perhaps a combined approach—incorporating regular surveillance with patient-reported outcomes—may be a worthwhile strategy.

“Sometimes we do things because they seem to be the right thing to do, even if the evidence suggests maybe we don’t need to do it,” he said. “We may need to change our paradigm on how we are taking care of these patients.”