Malignant brain astrocytomas: Extent of resection affects survival

Malignant astrocytomas, which include anaplastic astrocytomas and glioblastomas (GBM) are the most common malignant primary central nervous system tumors in adults. Despite advances in medical and surgical therapy, the median survival for patients harboring these tumors remains less than 2 years. This shortened survival has made many wonder if aggressive surgical resection prolongs survival for patients with malignant astrocytomas. For many solid organ malignant tumors, gross total resection with clear margins is associated with extended survival. However, the effect of extensive resection on prolonging survival for patients with malignant astrocytomas is less clear. This lack of clarity is confounded by the fact that these tumors are frequently invasive and widely in fi ltrative, and often involve eloquent areas. Aggressive surgery therefore may be associated with new de fi cits. This chapter evaluates the role that aggressive resection has on survival for patients with malignant astrocytomas.