Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma: A Systematic Review and Meta-Analysis

Yang, Kaiyun; Nath, Siddharth; Koziarz, Alex; Badhiwala, Jetan H.; Ghayur, Huphy; Sourour, Michel; Catana, Dragos; Nassiri, Farshad; Alotaibi, Mazen; Kameda-Smith, Michelle; Manoranjan, Branavan; Aref, Mohammed; Mansouri, Alireza; Singh, Sheila K.; Almenawer, Saleh A.

doi:10.1016/j.wneu.2018.08.163

Cited by 27 publications

(14 citation statements)

References 63 publications

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“…Two meta-analyses including studies of primary lowgrade gliomas show that extent of resection is a significant prognostic factor for PFS and/or OS. 88,89 Maximal safe resection may also delay or prevent malignant progression [89][90][91] and recurrence. 92 Patients who undergo an STR, open biopsy, or stereotactic biopsy are, therefore, considered to be at higher risk for progression.…”

Section: Surgerymentioning

confidence: 99%

Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology

Nabors

Portnow

Ahluwalia

et al. 2020

Journal of the National Comprehensive Cancer Network

354

238

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The NCCN Guidelines for Central Nervous System (CNS) Cancers focus on management of adult CNS cancers ranging from noninvasive and surgically curable pilocytic astrocytomas to metastatic brain disease. The involvement of an interdisciplinary team, including neurosurgeons, radiation therapists, oncologists, neurologists, and neuroradiologists, is a key factor in the appropriate management of CNS cancers. Integrated histopathologic and molecular characterization of brain tumors such as gliomas should be standard practice. This article describes NCCN Guidelines recommendations for WHO grade I, II, III, and IV gliomas. Treatment of brain metastases, the most common intracranial tumors in adults, is also described.

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Section: Surgerymentioning

confidence: 99%

Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology

Nabors

Portnow

Ahluwalia

et al. 2020

Journal of the National Comprehensive Cancer Network

354

238

View full text Add to dashboard Cite

show abstract

“…The extent of resection (EOR) is a fundamental topic in neurosurgery; if feasible and safely achievable, the gross total resection (GTR) is the most important predictor of overall survival both in high-grade gliomas (HGG) and in metastases (2, 3, 5–9). Furthermore, GTR reduces the risk of recurrence of low-grade gliomas (LGG) or other benign tumors (10, 11). For solitary metastasis, surgical resection plus adjuvant radiotherapy, in form of whole brain radiotherapy or stereotactic radiosurgery, is considered the gold therapeutic standard (12–14); complete metastases resection associated to a favorable factor for prolonged survival.…”

Section: Introductionmentioning

confidence: 99%

Fluorescein Application in Cranial and Spinal Tumors Enhancing at Preoperative MRI and Operated With a Dedicated Filter on the Surgical Microscope: Preliminary Results in 279 Patients Enrolled in the FLUOCERTUM Prospective Study

et al. 2019

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Objective: Sodium fluorescein, a green, water soluble dye, is used as neurosurgical fluorescent tracer thanks to its property to accumulate in cerebral regions of blood-brain barrier (BBB) disruption. The authors report the preliminary results of a prospective observational study regarding the use of fluorescein-guided technique for the resection of suspected malignant neoplasms of the central nervous system (CNS), contrast enhancing at preoperative magnetic resonance imaging (MRI), using a dedicated filter on the surgical microscope. Methods: In March 2016 the authors started a prospective, observational trial to evaluate intraoperative fluorescence's characteristics of CNS tumors, the percentage of extent of resection thanks to fluorescein aid and side effects related to fluorescein administration. This report is based on a preliminary analysis of the results of first 279 enrolled patients. Fluorescein was intravenously injected after intubation or immediately at the entrance in the operating room for awake procedures; the tumor was removed using a dedicated filter on the surgical microscope in an inside-out fashion until all fluorescent tissue was removed, as considered feasible by the surgeon. Results: The 279 patients finally enrolled in the trial, both firstly diagnosed and recurrent, were categorized according to WHO pathological classification and there were 212 neuroepithelial tumors, 25 brain metastases, 10 cerebral lymphomas, 7 hemangioblastomas, or hemangioendotheliomas and 25 other tumors and conditions. No adverse reaction related to the administration of fluorescein or to the combined use of fluorescein with other fluorophores was registered. Fluorescein accumulated in cerebral regions where the BBB was damaged, representing a significant surgical aid in most of the CNS tumors with contrast enhancement. In cases of complete removal of all fluorescent tissue, as intraoperatively judged by the surgeon, postoperative MRI revealed a gross total resection in 181/198 patients (91.4%). Conclusions: Based on these preliminary results, fluorescein-guided surgery with a dedicated filter on the microscope is a safe and effective technique to improve visualization and resection of different CNS tumors and conditions, based on BBB alteration.

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“…We also recorded the management of tumors, including wait-and-see, surgery, chemotherapy, and radiotherapy approaches. We collected data on the type of surgical resection (gross total-and subtotal-resection (respectively GTR and STR) [82,83], duration of follow-up, recurrence, progression, or resolution. Ethical approval from local committees was obtained.…”

Section: Methodsmentioning

confidence: 99%

Retrospective Multicentric Study on Non-Optic CNS Tumors in Children and Adolescents with Neurofibromatosis Type 1

Santoro

Picariello

Palladino

et al. 2020

Cancers

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The natural history of non-optic central nervous system (CNS) tumors in neurofibromatosis type 1 (NF1) is largely unknown. Here, we describe prevalence, clinical presentation, treatment, and outcome of 49 non-optic CNS tumors observed in 35 pediatric patients (0–18 years). Patient- and tumor-related data were recorded. Overall survival (OS) and progression-free survival (PFS) were evaluated. Eighteen patients (51%) harbored an optic pathway glioma (OPG) and eight (23%) had multiple non-optic CNS lesions. The majority of lesions (37/49) were managed with a wait-and-see strategy, with one regression and five reductions observed. Twenty-one lesions (42.9%) required surgical treatment. Five-year OS was 85.3%. Twenty-four patients progressed with a 5-year PFS of 41.4%. Patients with multiple low-grade gliomas progressed earlier and had a lower 5-year PFS than those with one lesion only (14.3% vs. 57.9%), irrespective of OPG co-presence. Non-optic CNS tumors are common in young patients with NF1. Neither age and symptoms at diagnosis nor tumor location influenced time to progression in our series. Patients with multiple lesions tended to have a lower age at onset and to progress earlier, but with a good OS.

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Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma: A Systematic Review and Meta-Analysis

Cited by 27 publications

References 63 publications

Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology

Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology

Fluorescein Application in Cranial and Spinal Tumors Enhancing at Preoperative MRI and Operated With a Dedicated Filter on the Surgical Microscope: Preliminary Results in 279 Patients Enrolled in the FLUOCERTUM Prospective Study

Retrospective Multicentric Study on Non-Optic CNS Tumors in Children and Adolescents with Neurofibromatosis Type 1

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