Role of Extent of Resection in the Long-Term Outcome of Low-Grade Hemispheric Gliomas

Smith, Justin S.; Chang, Edward F.; Lamborn, Kathleen R.; Chang, Susan M.; Prados, Michael D.; Cha, Soonmee; Tihan, Tarık; VandenBerg, Scott R.; McDermott, Michael W.; Berger, Mitchel S.

doi:10.1200/jco.2007.13.9337

Cited by 1,173 publications

(717 citation statements)

References 31 publications

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“…When these residual cells are not eradicated by adjuvant treatments, they give rise to recurrences. The volume of residual cancer following surgery negatively impacts overall survival (4,(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Highly Accurate Detection of Cancer In Situ with Intraoperative, Label-Free, Multimodal Optical Spectroscopy

et al. 2017

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Effectiveness of surgery as a cancer treatment is reduced when all cancer cells are not detected during surgery, leading to recurrences that negatively impact survival. To maximize cancer cell detection during cancer surgery, we designed an in situ intraoperative, label-free, optical cancer detection system that combines intrinsic fluorescence spectroscopy, diffuse reflectance spectroscopy, and Raman spectroscopy. Using this multimodal optical cancer detection system, we found that brain, lung, colon, and skin cancers could be detected in situ during surgery with an accuracy, sensitivity, and specificity of 97%, 100%, and 93%, respectively. This highly sensitive optical molecular imaging approach can profoundly impact a wide range of surgical and noninvasive interventional oncology procedures by improving cancer detection capabilities, thereby reducing cancer burden and improving survival and quality of life.

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Section: Introductionmentioning

confidence: 99%

Highly Accurate Detection of Cancer In Situ with Intraoperative, Label-Free, Multimodal Optical Spectroscopy

et al. 2017

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“…Substantial evidence suggests that a smaller volume of postoperative residual tumor is associated with an improved prognosis (1)(2)(3)(4). One of the greatest barriers to achieving optimal surgical results in infiltrative tumors is the difficulty in distinguishing tumor from normal brain (5)(6)(7).…”

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confidence: 99%

Ambient mass spectrometry for the intraoperative molecular diagnosis of human brain tumors

Eberlin

Norton²,

Orringer³

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

263

234

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The main goal of brain tumor surgery is to maximize tumor resection while preserving brain function. However, existing imaging and surgical techniques do not offer the molecular information needed to delineate tumor boundaries. We have developed a system to rapidly analyze and classify brain tumors based on lipid information acquired by desorption electrospray ionization mass spectrometry (DESI-MS). In this study, a classifier was built to discriminate gliomas and meningiomas based on 36 glioma and 19 meningioma samples. The classifier was tested and results were validated for intraoperative use by analyzing and diagnosing tissue sections from 32 surgical specimens obtained from five research subjects who underwent brain tumor resection. The samples analyzed included oligodendroglioma, astrocytoma, and meningioma tumors of different histological grades and tumor cell concentrations. The molecular diagnosis derived from mass-spectrometry imaging corresponded to histopathology diagnosis with very few exceptions. Our work demonstrates that DESI-MS technology has the potential to identify the histology type of brain tumors. It provides information on glioma grade and, most importantly, may help define tumor margins by measuring the tumor cell concentration in a specimen. Results for stereotactically registered samples were correlated to preoperative MRI through neuronavigation, and visualized over segmented 3D MRI tumor volume reconstruction. Our findings demonstrate the potential of ambient mass spectrometry to guide brain tumor surgery by providing rapid diagnosis, and tumor margin assessment in near-real time.

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“…Comparing biopsy with early resection, a significantly higher 5-year survival has been shown for early resection in low-grade gliomas [2]. Over the last years, a growing body of evidence is in favor of extent of resection of low-grade gliomas to improve overall and progression-free survival [3]. These findings should also be applicable for thalamic low-grade gliomas.…”

Section: Thalamic Low-grade Gliomamentioning

confidence: 93%

Endoscopic low-grade glioma surgery: a tool for maximizing safe resection?

Lehmberg

2017

Acta Neurochir

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EndoscopyThe endoscope is largely seen as a minimally invasive surgical technique, and minimizing the invasiveness in surgery is a general trend, which is for a large number of patients the crucial point when opting for a treatment. Yes, the endoscope is a great tool for improving the visualization in deep and narrow corridors, but seeing the lesion does not automatically enable resecting it. The resection is highly dependent on the maneuverability of the surgical instrument, which is limited by the narrow and deep corridor along the endoscope. NeuroendoscopyIn the beginning of the neuroendoscopy era, those propagating this technique were criticized that the new technique is not as safe as open microsurgery. Over the years we learned how to select cases, and we can well estimate the risk for a certain endoscopic procedure. Some procedures like ventriculostomy have become routine also in non-specialized neurosurgical units. Although the endoscope was introduced in neurosurgery decades ago, the microscope is still the workhorse for magnification. Especially gliomas are still routinely operated via an open approach; some experienced glioma surgeons prefer loupes over the microscope to gain a better anatomic overview for a superior preservation of function. One of the main challenges in endoscopic glioma surgery, especially in high-grade gliomas, is to control bleeding from the tumor bed. Here again, the limited maneuverability of the bipolar forceps along the endoscope (but also blood spilling on the lens) are the main restrictions. Therefore it is great to see academic groups pushing the field. Brokinkel et al.[1] describe in their case report a thalamic low-grade glioma, which has been resected via a parietal transventricular approach. Their experience in that case was that the transsulcal corridor was too narrow to visualize the tumor with the microscope, but after insertion of a Hopkins endoscope, tumor resection was feasible. Thalamic low-grade gliomaThalamic gliomas are a rare subset of gliomas, but low-grade thalamic gliomas are even more rare. These deep-seated tumors are challenging to resect, therefore stereotactic biopsy followed by radiation and chemotherapy is considered to be the safer treatment over surgical resection. Comparing biopsy with early resection, a significantly higher 5-year survival has been shown for early resection in low-grade gliomas [2]. Over the last years, a growing body of evidence is in favor of extent of resection of low-grade gliomas to improve overall and progression-free survival [3]. These findings should also be applicable for thalamic low-grade gliomas.

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Role of Extent of Resection in the Long-Term Outcome of Low-Grade Hemispheric Gliomas

Abstract: Improved outcome among adult patients with hemispheric LGG is predicted by greater EOR.

Cited by 1,173 publications

References 31 publications

Highly Accurate Detection of Cancer In Situ with Intraoperative, Label-Free, Multimodal Optical Spectroscopy

Highly Accurate Detection of Cancer In Situ with Intraoperative, Label-Free, Multimodal Optical Spectroscopy

Ambient mass spectrometry for the intraoperative molecular diagnosis of human brain tumors

Endoscopic low-grade glioma surgery: a tool for maximizing safe resection?

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