Considerations on neurological deficits in patients with glioblastoma: impact of perilesional resection on neuro-oncological outcome. A monocentric real-life experience

Introduction: Maximal resection has a pivotal role in the treatment of glioblastoma (GB), prolonging both progression free survival (PFS) and overall survival (OS). Only few studies analyze the delicate equilibrium between maximal resection, clinical outcome and prognosis. Research question: the aim of this work is to determine the impact of neurological impairment on PFS, OS and access to adjuvant therapies on patients with GB operated with perilesional resection technique. Material and Methods: this retrospective study encompassed patients operated for GB at Fondazione IRCCS San Gerardo dei Tintori Monza (IT), from 2015 to 2023. Histological diagnosis was performed according to the WHO 2021 classification. Patients were more than 18 years old, with preand postoperative MRI, who underwent surgery and adjuvant treatments at our Institution. Results: A total of 209 patients fulfilled the criteria. Patients with improvement or complete regression of preoperative deficit had a higher rate of access to adjuvant therapies (p = 0.015). Patients with hemiparesis at discharge had the worst PFS (median 4.60 months) followed by patients with aphasia (6.60 months), and patients with normal neurological examination (9.67 months; p < 0.0001). The median OS was 17.93 months for patients with hemianopia, 6.40 for patients with hemiparesis and 15.7 months for those with aphasia (p < 0.0001). Discussion and conclusion: Hemianopia has no impact on the patient's prognosis, while hemiparesis and aphasia at discharge worsen both PFS and OS prolonging time-to-treatment. When resecting GB, it is mandatory to avoid major neurological deficits that concur which reduce OS and PFS.