Combined use of multimodal techniques for the resection of glioblastoma involving corpus callosum

Abstract

Purpose To compare the multimodal techniques (including neuronavigation, intraoperative MRI [iMRI], and neuromonitoring [IONM]) and conventional approach (only guided by neuronavigation) in removing glioblastoma (GBM) with corpus callosum (CC) involvement (ccGBM), their effectiveness and safety were analyzed and compared. Methods Electronic medical records were retrospectively reviewed for ccGBM cases treated in our hospital between January 2016 and July 2020. Patient demographics, tumor characteristics, clinical outcomes, extent of resection (EOR), progression-free survival (PFS), and overall survival (OS) were obtained and compared between the multimodal group (used multimodal techniques) and the conventional group (only used neuronavigation). Both groups only included patients that had maximal safe resection (not biopsy). Postoperative radiochemotherapy was also performed or not. Univariate and multivariate analyses were performed to identify significant prognostic factors and optimal EOR threshold. Results Finally 56 cases of the multimodal group and 21 cases of the conventional group were included. The multimodal group achieved a higher median EOR (100% versus 96.1%, P = 0.036) and gross total resection rate (60.7% versus 33.3%, P = 0.032) and a lower rate of permanent motor deficits (5.4% versus 23.8%, P = 0.052) than the conventional approach. The multimodal group had the longer median PFS (10.9 versus 7.0 months, P = 0.023) and OS (16.1 versus 11.6 months, P = 0.044) than the conventional group. Postoperative language and cognitive function were similar between the two groups. In multivariate analysis, a higher EOR, radiotherapy, and longer cycles of temozolomide chemotherapy were positive prognostic factors for survival of ccGBM. An optimal EOR threshold of 92% was found to significantly benefit the PFS (HR = 0.51, P = 0.036) and OS (HR = 0.49, P = 0.025) of ccGBM. Conclusion Combined use of multimodal techniques can optimize the safe removal of ccGBM. Aggressive resection of EOR > 92% using multimodal techniques combined with postoperative radiochemotherapy should be suggested for ccGBM.

Nomograms for prognostic risk assessment in glioblastoma multiforme: Applications and limitations

“…At present, the initial GBM treatment is maximum safe resection, followed by radiotherapy and chemotherapy, and recurrent GBM can be treated by different methods, including local and systemic treatments. 22 Through the analysis for GBM treatment measures, we find that surgery, radiotherapy and chemotherapy are all beneficial to the survival of GBM patients, and radiotherapy has more reliable therapeutic effects (Figure 5). Some studies have found that preoperative or postoperative radiotherapy can improve PFS and OS.…”

“…At present, the initial GBM treatment is maximum safe resection, followed by radiotherapy and chemotherapy, and recurrent GBM can be treated by different methods, including local and systemic treatments 22 …”

Prognostic differences and implications on treatment strategies between butterfly glioblastoma and glioblastoma with unilateral corpus callosum infiltration

“…On a molecular level, Cui et al found that glioblastoma with corpus callosum affection tend to have a higher incidence of platelet derived growth factor receptor alpha alterations than glioblastoma without corpus callosum involvement which in turn is associated with worse survival. Furthermore, patients with glioblastoma affecting the corpus callosum had a lower extent of resection rates than their counterparts with glioblastoma without corpus callosum infiltration 19 . For these reasons, tumors with corpus callosum involvement are more often considered for biopsy than for resection, which is probably at least partly responsible for the worse overall survival in this patient population.…”

Perspective Chapter: Glioblastoma of the Corpus Callosum

“…Surgical approaches help in reducing the tumour burden [11,35,37,38] and also provide tissue sample for pathologic and molecular characterisation of the tumour (IDH 1/2 mutation or MGMT promoter methylation or both), thus guiding the further adjuvant management approaches [35]. Surgical resection can also be facilitated by intraoperative magnetic resonance imaging MRI-guided laser interstitial thermal therapy (LITT) techniques as this will increase the efficacy and safety of the procedure [37,[39][40][41]. Evidence suggests that preoperative KPS score, adjuvant radio chemotherapy and extent of surgical resection (EoR) have impact on survival besides patient's age.…”