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25, 50 & 75 years ago

A.H. Kaye. Re-operation for recurrent malignant brain tumours: is it worthwhile? ANZ J. Surg. 1992; 62: 677–9 Malignant primary brain tumours invariably recur. Brain tumours account for 2% of cancer deaths and nearly all of these are because of the infiltrating high-grade cerebral glioma. Initial treatment of these tumours usually involves surgery and radiotherapy, although some other adjuvant therapies such as chemotherapy and photodynamic therapy are sometimes used. Whatever the treatment, high-grade gliomas recur. Despite the best conventional treatment, the median survival of patients with primary brain tumours is less than 1 year and only 5% of patients live longer than 2 years. In general, the frequency of re-operation for recurrent cerebral glioma has been low, and the operation is performed only in patients in good neurological condition with tumours in surgically accessible sites. Re-operation has usually been undertaken in a sporadic fashion and there are only a few large modem series that have been able to use the technical advances developed during the past decade. The usual nihilistic approach to recurrent malignant gliomas has been thought to be justified because of the poor prognosis. However, this belief should be tempered by a realistic attitude that re-operation can be useful in some patients by both improving their quality of life and enhancing their length of survival. In a time of limited medical resources re-appraisal of the usefulness of surgery for recurrent gliomas is appropriate and it is essential to identify those patients most likely to benefit from further surgery.