Practice variation in re-resection for recurrent glioblastoma: A nationwide survey among Dutch neuro-oncology specialists

Mark P van Opijnen; Filip Y F de Vos; Rob J A Nabuurs; Tom J Snijders; Rishi D S Nandoe Tewarie; Walter Taal; Joost J C Verhoeff; Jacobus J M van der Hoeven; Marike L D Broekman

doi:10.1093/nop/npad016

Practice variation in re-resection for recurrent glioblastoma: A nationwide survey among Dutch neuro-oncology specialists

Neurooncol Pract. 2023 Mar 14;10(4):360-369. doi: 10.1093/nop/npad016. eCollection 2023 Aug.

Authors

Affiliations

¹ Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands.
² Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
³ Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁴ Department of Neurosurgery, Haga Teaching Hospital, The Hague, The Netherlands.
⁵ Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
⁶ Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
⁷ Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁸ Hartwig Medical Foundation, Amsterdam, The Netherlands.

Abstract

Background: Despite current best treatment options, a glioblastoma almost inevitably recurs after primary treatment. However, in the absence of clear evidence, current guidelines on recurrent glioblastoma are not well-defined. Re-resection is one of the possible treatment modalities, though it can be challenging to identify those patients who will benefit. Therefore, treatment decisions are made based on multidisciplinary discussions. This study aimed to investigate the current practice variation between neuro-oncology specialists.

Methods: In this nationwide study among Dutch neuro-oncology specialists, we surveyed possible practice variation. Via an online survey, 4 anonymized recurrent glioblastoma cases were presented to neurosurgeons, neuro-oncologists, medical oncologists, and radiation oncologists in The Netherlands using a standardized questionnaire on whether and why they would recommend a re-resection or not. The results were used to provide a qualitative analysis of the current practice in The Netherlands.

Results: The survey was filled out by 56 respondents, of which 15 (27%) were neurosurgeons, 26 (46%) neuro-oncologists, 2 (4%) medical oncologists, and 13 (23%) radiation oncologists. In 2 of the 4 cases, there appeared to be clinical equipoise. Overall, neurosurgeons tended to recommend re-resection more frequently compared to the other specialists. Neurosurgeons and radiation oncologists showed opposite recommendations in 2 cases.

Conclusions: This study showed that re-resection of recurrent glioblastoma is subject to practice variation both between and within neuro-oncology specialties. In the absence of unambiguous guidelines, we observed a relationship between preferred practice and specialty. Reduction of this practice variation is important; to achieve this, adequate prospective studies are essential.

Keywords: Glioblastoma; practice variation; re-resection; recurrence; survey.

© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.