Neurosurgeons Disagree on Resectability in Recurrent Glioblastoma Trial

Glioblastoma remains the most frequent and aggressive primary malignancy of the central nervous system, almost inevitably recurring despite initial multimodal therapy (17, 20). While the standard of care for newly diagnosed disease is well established, the management of first recurrence is far less standardized, often involving a complex choice between systemic salvage therapies, re-irradiation, or repeat surgical intervention (12, 18). Clinical guidelines emphasize the importance of achieving a maximal safe resection, defined as the removal of as much tumor as possible without causing new neurological deficits, to improve survival outcomes and quality of life (18, 20). However, the definition of resectability remains elusive because it relies on a surgeon's subjective interpretation of preoperative imaging and the perceived risk to functional brain regions (19, 20). This lack of objective criteria complicates both clinical trial enrollment and the development of consistent treatment algorithms for patients facing disease progression. To address this gap, a post-hoc analysis of a prospective trial now examines the degree of consensus among expert neuro-oncologists when evaluating candidates for re-resection, highlighting the challenges physicians face when determining surgical candidacy.