156 Multidisciplinary decision-making in the management of recurrent glioblastoma - a multi-centre UK questionnaire study

Abstract

Recurrent glioblastoma (GB) carries a poor prognosis, with progressive physical and cognitive deterioration affecting both quality of life and survival. There is limited evidence guiding optimal management including uncertainty around the role of re-resection. We surveyed UK neuro-oncology specialists to evaluate agreement in treatment recommendations for recurrent GB and to identify clinical factors influencing decisions. A 35-item questionnaire was distributed to consultant neuro-oncology surgeons and neuro-oncologists across the UK between December 2023 and April 2024. Respondents evaluated seven simulated clinical vignettes depicting first GB recurrence and selected feasible treatment options and their single preferred option. The survey assessed which clinical factors inform decisions and the extent of multi-disciplinary team (MDT) involvement. 38 responses were received from 23 consultant neuro-oncology surgeons and 15 consultant neuro-oncologists across 22 sites with a response rate of 73%. Only 71% routinely re-discussed all recurrent GB cases at MDT meetings, with higher rates among neuro-oncology surgeons. Common reasons not involving MDTs included advanced age, poor performance status, multifocality, unfavourable location or early recurrence. Across vignettes, repeat resection prior to chemotherapy was preferred for focal, late recurrences but rarely considered an option for deeply-sited or multifocal disease. Second-line chemotherapy was deemed feasible in most scenarios. Re-irradiation was infrequently selected except for late recurrences with good performance status. Best supportive care was identified as an appropriate option alongside active treatments. Key factors influencing re-resection decisions included anticipated resection extent, performance status, tumour eloquence, number of disease foci and time to recurrence. Substantial inter-clinician variability in management preferences indicates considerable clinical equipoise in recurrent GB management. Our study identified significant support amongst neuro-oncology specialists for randomised intervention trials, particularly regarding the role of re-resection surgery.