Clinical outcomes of early salvage surgery for residual or enlarging contrast-enhancing lesions after radiotherapy in patients with glioblastoma.

BACKGROUND: Patients with glioblastoma frequently present contrast-enhancing lesions at radiotherapy completion; however, their clinical significance and optimal management remain unclear. This study evaluated the clinical outcomes of early salvage surgery performed immediately after radiotherapy completion. METHODS: This retrospective single-center study included adult patients with supratentorial glioblastoma receiving standard chemoradiotherapy. The initial extent of resection was classified using postoperative magnetic resonance imaging according to the RANO resect framework. Early salvage surgery was defined as repeat craniotomy for safely resectable post-radiotherapy contrast-enhancing lesions before maintenance chemotherapy initiation. The Kaplan-Meier method and Cox proportional hazards models were used to analyze overall survival (OS). RESULTS: Post-radiotherapy contrast-enhancing lesions were identified in 118 of 174 eligible patients (67.8%). Patients with lower initial RANO resect classes more frequently demonstrated enlarging contrast-enhancing lesions at radiotherapy completion. Early salvage surgery was performed in 17 patients (14.4%). Gross total resection (0 cm3 residual) and near-total resection (<1 cm3 residual) were achieved in 5 and 4 patients, respectively. Histopathological examination revealed viable tumor components with treatment-related changes in all resected specimens. Multivariate analysis of patients with post-radiotherapy contrast-enhancing lesions identified an independent association between early salvage surgery and longer OS (hazard ratio = 0.440, p = 0.021). Surgical morbidity included postoperative decline in Karnofsky Performance Status in two patients and wound-related complications in two patients. CONCLUSIONS: Early salvage surgery for post-radiotherapy contrast-enhancing lesions was independently associated with longer OS and may represent a feasible treatment option in carefully selected patients within multidisciplinary glioblastoma management.