An extent of resection threshold for newly diagnosed glioblastomas

Sanai, Nader; Polley, Mei Yin; McDermott, Michael W.; Parsa, Andrew T.; Berger, Mitchel S.

doi:10.3171/2011.2.jns10998

Cited by 1,352 publications

(970 citation statements)

References 13 publications

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“…In patients with newly diagnosed glioblastomas, increased EOR parallels improvements in overall survival, even at the highest levels of resection, and subtotal resections as low as 78% confer survival benefits. 9) Our results are similar to these findings (Table 1). In our series, the resection rate of LGG was lower than that of HGG.…”

Section: Discussionsupporting

confidence: 83%

Usefulness of Multimodal Examination and Intraoperative Magnetic Resonance Imaging System in Glioma Surgery

Sakurada

Matsuda

Funiu

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Extensive surgical removal of tumor tissue can contribute to longer survival for patients with gliomas. Intraoperative magnetic resonance (iMR) imaging is important for safe and maximal resection of brain tumors. A new operating room equipped with a 1.5-T MR imaging system and neuronavigation opened at Yamagata University Hospital in 2008. Using this new suite, we have safely treated over 200 cases. Use of iMR imaging improved glioma resection rates in 25 (34%) of 73 cases, and gross total resection was achieved in 48 patients (66%). Motor evoked potential (MEP) monitoring was performed in combination with iMR imaging for 32 gliomas. MEP monitoring was successful in 30 cases (94%). Transient decreases in MEP amplitude were seen in two patients. One patient showed transient motor weakness and another showed improvement of motor function. The iMR imaging system provides useful information for tumor resection that allows intraoperative modification of surgical strategies. Combining MEP monitoring with iMR imaging appears to offer the most effective method for safe glioma surgery near eloquent areas.

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Section: Discussionsupporting

confidence: 83%

Usefulness of Multimodal Examination and Intraoperative Magnetic Resonance Imaging System in Glioma Surgery

Sakurada

Matsuda

Funiu

et al. 2012

Neurol. Med. Chir.(Tokyo)

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“…[3][4][5][6][7] As the extent of surgical resection is known to significantly impact patient prognosis [8][9][10] , whether "biopsy-only" GBM patients receive a significant survival benefit to CRT over radiotherapy (RT) alone is less clear.…”

Section: Introductionmentioning

confidence: 99%

Concurrent chemoradiotherapy versus radiotherapy alone for “biopsy‐only” glioblastoma multiforme

Kole

Park

Yeboa

et al. 2016

Cancer

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BACKGROUND Combined temozolomide and radiotherapy (RT) is the standard postoperative therapy for glioblastoma multiforme (GBM). However, the clearest benefit of concurrent chemoradiotherapy (CRT) observed in clinical trials has been among patients who undergo surgical resection. Whether the improved survival with CRT extends to patients who undergo “biopsy only” is less certain. The authors compared overall survival (OS) in a national cohort of patients with GBM who underwent biopsy and received either RT alone or CRT during the temozolomide era. METHODS The US National Cancer Data Base was used to identify patients with histologically confirmed, biopsy‐only GBM who received either RT alone or CRT from 2006 through 2011. Demographic and clinicopathologic predictors of treatment were analyzed using the chi‐square test, the t test, and multivariable logistic regression. OS was evaluated using the log‐rank test, multivariable Cox proportional hazard regression, and propensity score‐matched analysis. RESULTS In total, 1479 patients with biopsy‐only GBM were included, among whom 154 (10.4%) received RT alone and 1325 (89.6%) received CRT. The median age at diagnosis was 61 years. CRT was associated with a significant OS benefit compared with RT alone (median, 9.2 vs 5.6 months; hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.54‐0.76; P < .001). CRT was independently associated with improved OS compared with RT alone on multivariable analysis (HR, 0.71; 95% CI, 0.60‐0.85; P < .001). A significant OS benefit for CRT persisted in a propensity score‐matched analysis (HR, 0.72; 95% CI, 0.56‐0.93; P = .009). CONCLUSIONS The current data suggest that CRT significantly improves OS in patients with GBM who undergo biopsy only compared with RT alone and should remain the standard of care for patients who can tolerate therapy. Cancer 2016;122:2364–2370. © 2016 American Cancer Society.

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“…16) The results indicated that resection exceeding 78% can impact patient survival, and that this trend continues even at the highest levels of resection. The study included elderly (range 20-90 years, median 60 years) and low KPS (range 20-100%, median 80%) patients.…”

Section: Discussionmentioning

confidence: 94%

“…17) The median OS was 12.2 months among 500 GBM patients (median age 60 years, median preoperative KPS 80%) in another institute. 16) The following variables were found to be significant prognostic factors favoring longer survival by multivariate analysis in the subtotal and partial groups: younger age, TMZ therapy, 60 Gy irradiation, MGMT-negative, and more than subtotal resection (Table 2). Some were previously reported to be prognostic factors for GBM.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of Maximal Safe Resection for Glioblastoma Including Elderly and Low Karnofsky Performance Status Patients: Retrospective Review at a Single Institute

Uzuka

Aoki

Natsumeda

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Elderly and low Karnofsky performance status (KPS) patients have been excluded from most prospective trials. This retrospective study investigated glioblastoma treatment outcomes, including those of elderly and low KPS patients, and analyzed the prognostic factors using the medical records of 107 consecutive patients, 59 men and 48 women aged from 21 to 85 years (median 65 years), with newly diagnosed glioblastoma treated at our institute. There were 71 high-risk patients with age À70 years and/or KPS º70%. Based on the extent of resection, the patients were classified into 3 groups: more than subtotal resection (subtotal, n ＝ 44), partial resection (partial, n ＝ 29), and biopsy only (biopsy, n ＝ 34). Median overall survival (OS) of all 107 patients was 13.5 months. Median OS was 13.2 months in the high-risk group. Median OSs were 15.8, 12.8, and 12.1 months in the subtotal, partial, and biopsy groups, respectively. Multivariate analysis of 73 patients in the subtotal and partial groups found age Ã65 years (p ＝ 0.047), 60 Gy irradiation (p ＝ 0.009), O 6 -methylguanine-deoxyribonucleic acid methyltransferase-negative (p ＝ 0.027), and more than subtotal removal (p ＝ 0.003) were significant prognostic factors. The median postoperative KPS score tended to be better than the preoperative score, even in the high-risk group. We recommend maximal safe resection for glioblastoma patients, even those with advanced age and/or with low KPS scores.

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An extent of resection threshold for newly diagnosed glioblastomas

Cited by 1,352 publications

References 13 publications

Usefulness of Multimodal Examination and Intraoperative Magnetic Resonance Imaging System in Glioma Surgery

Usefulness of Multimodal Examination and Intraoperative Magnetic Resonance Imaging System in Glioma Surgery

Concurrent chemoradiotherapy versus radiotherapy alone for “biopsy‐only” glioblastoma multiforme

Effectiveness of Maximal Safe Resection for Glioblastoma Including Elderly and Low Karnofsky Performance Status Patients: Retrospective Review at a Single Institute

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