Surgery for temporal glioblastoma: lobectomy outranks oncosurgical-based gross-total resection

Schneider, Matthias; Potthoff, Anna-Laura; Keil, Vera C.; Güresir, Ági; Weller, Johannes; Borger, Valeri; Hamed, Motaz; Waha, Andreas; Vatter, Hartmut; Güresir, Erdem; Herrlinger, Ulrich; Schuss, Patrick

doi:10.1007/s11060-019-03281-1

Cited by 34 publications

(29 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Given the growing evidence of a greater extent of malignant primary brain tumor resection to entail significantly prolonged time to tumor progression and superior overall survival rates, the concept of supra-total resection strategies far beyond tumoral enhancing MRI abnormalities is increasingly emerging in the field of neurosurgical oncology [ 6 , 15 – 17 ]. In a recent study, we could demonstrate that—in temporal glioblastoma disease—ATL as a paradigm for such supra-marginal extended surgery regimes was accompanied by a significant survival benefit compared to conventional gadolinium- and 5-ALA-guided temporal GTRs [ 8 ]. However, the aim of aggressive extended surgical approaches has to surrender the risk of potential elevated levels of postoperative complications [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…The current study is the first to provide data on postoperative complications of supra-total tumor resection in the setting of specifically temporal-located glioblastoma disease. In contrast to the inconsistent perception of the extent of supra-total tumor removal within the existing literature varying from resection beyond T1-enhanced tumor areas, but within the boundaries of FLAIR abnormalities, to resection beyond any visible MRI abnormality, ATL as a maximum variant of a supra total resection policy with excision of the entire anterior temporal lobe constitutes a highly-standardized and clearly-defined procedure [ 8 , 30 , 31 ]. Therefore, subsequent rather multicenter studies will be capable not only to cope with the low frequency of temporal glioblastoma patients, but also to sufficiently evaluate the potential of ATL by means of intercenter comparison to supersede a mere complete tumor bulk removal and thus constitute the surgical modality of choice for temporal-located glioblastoma.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, extended supra-marginal glioblastoma resection should provide for superior long-term disease control and several studies have reported a survival benefit in these extended-resected patient cohorts, so far [ 5 – 7 ]. Recently, it has been demonstrated that in temporal glioblastoma disease resection of the entire anterior temporal lobe as a maximum variant of such supra-total conceptual approaches yielded significant prolonged median progression-free survival (mPFS) and median overall survival (mOS) rates therefore suggesting anterior temporal lobectomy (ATL) to constitute the surgical modality of choice for temporal-located glioblastoma [ 8 ]. However, given a potential increased impairment of eloquent areas and critical vasculature at risk, supra-marginal resection regimes might be accompanied by elevated levels of postoperative unfavorable events which in turn significantly worsen patients’ postoperative quality of life [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Safety metric profiling in surgery for temporal glioblastoma: lobectomy as a supra-total resection regime preserves perioperative standard quality rates

et al. 2020

Self Cite

View full text Add to dashboard Cite

Introduction Supra-total resection in terms of anterior temporal lobectomy (ATL) has gained growing attention with regard to superior long-term disease control for temporal-located glioblastoma. However, aggressive onco-surgical approaches—geared beyond conventional gross total resections (GTR)—may be associated with peri- and postoperative unfavorable events which significantly worsen initial favorable postoperative outcome. In the current study we analyzed our institutional database with regard to patient safety indicators (PSIs), hospital-acquired conditions (HACs) and specific cranial surgery-related complications (CSC) as high standard quality metric profiles in patients that had undergone surgery for temporal glioblastoma. Methods Between 2012 and 2018, 61 patients with temporal glioblastoma underwent GTR or temporal lobectomy at the authors’ institution. Both groups of differing resection modalities were analyzed with regard to the incidence of PSIs, HACs and CSCs. Results Overall, we found 6 PSI and 2 HAC events. Postoperative hemorrhage (3 out of 61 patients; 5%) and catheter-associated urinary tract infection (2 out 61 patients; 3%) were identified as the most frequent PSIs and HACs. PSIs were present in 1 out of 41 patients (5%) for the temporal GTR and 2 out of 20 patients for the lobectomy group (p = 1.0). Respective rates for PSIs were 5 of 41 (12%) and 1 of 20 (5%) (p = 0.7). Further, CSCs did not yield significant differences between these two resection modalities (p = 1.0). Conclusion With regard to ATL and GTR as differing onco-surgical approaches these data suggest ATL in terms of an aggressive supra-total resection strategy to preserve perioperative standard safety metric profiles.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Safety metric profiling in surgery for temporal glioblastoma: lobectomy as a supra-total resection regime preserves perioperative standard quality rates

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Treatment decisions were made at the initial presentation of the patient and during follow-up by the institutional interdisciplinary tumor board meetings of the Center of Neurooncology, as described previously [ 6 ].…”

Section: Methodsmentioning

confidence: 99%

Newly diagnosed glioblastoma in geriatric (65 +) patients: impact of patients frailty, comorbidity burden and obesity on overall survival

et al. 2020

Self Cite

View full text Add to dashboard Cite

Object Increasing age is a known negative prognostic factor for glioblastoma. However, a multifactorial approach is necessary to achieve optimal neuro-oncological treatment. It remains unclear to what extent frailty, comorbidity burden, and obesity might exert influence on survival in geriatric glioblastoma patients. We have therefore reviewed our institutional database to assess the prognostic value of these factors in elderly glioblastoma patients. Methods Between 2012 and 2018, patients aged ≥ 65 years with newly diagnosed glioblastoma were included in this retrospective analysis. Patients frailty was analyzed using the modified frailty index (mFI), while patients comorbidity burden was assessed according to the Charlson comorbidity index (CCI). Body mass index (BMI) was used as categorized variable. Results A total of 110 geriatric patients with newly diagnosed glioblastoma were identified. Geriatric patients categorized as least-frail achieved a median overall survival (mOS) of 17 months, whereas most frail patients achieved a mOS of 8 months (p = 0.003). Patients with a CCI > 2 had a lower mOS of 6 months compared to patients with a lower comorbidity burden (12 months; p = 0.03). Multivariate analysis identified “subtotal resection” (p = 0.02), “unmethylated MGMT promoter status” (p = 0.03), “BMI < 30” (p = 0.04), and “frail patient (mFI ≥ 0.27)” (p = 0.03) as significant and independent predictors of 1-year mortality in geriatric patients with surgical treatment of glioblastoma (Nagelkerke's R2 0.31). Conclusions The present study concludes that both increased frailty and comorbidity burden are significantly associated with poor OS in geriatric patients with glioblastoma. Further, the present series suggests an obesity paradox in geriatric glioblastoma patients.

show abstract

“…In this context, KPS ≥ 70 was defined as a favorable outcome. Treatment decisions were made at the initial presentation of the patient and during follow-up by the institutional interdisciplinary tumor advisory board meetings for the Central Nervous System, as described previously (6). Extent of resection (EOR) was assessed in early (<72 h) postoperative magnetic resonance imaging (MRI, 3T).…”

Section: Patientsmentioning

confidence: 99%

Postoperative Prolonged Mechanical Ventilation in Patients With Newly Diagnosed Glioblastoma—An Unrecognized Prognostic Factor

et al. 2020

Self Cite

View full text Add to dashboard Cite

ObjectiveAlthough the treatment of glioblastoma patients is well established in neuro-oncological surgery, precious scarce data is available on patients with glioblastoma requiring postoperative prolonged mechanical ventilation (PMV). Therefore, the aim of the present study was to determine the influence of PMV on overall survival (OS) in patients with glioblastoma.MethodsPatients with newly diagnosed glioblastoma who had undergone surgical therapy and complete subsequent neuro-oncological treatment at the authors’ neuro-oncological center from January 2013 to December 2018 were selected and included in the further analysis. PMV was defined as mechanical ventilation for more than 24 h after surgery. Survival analyses were performed, including established prognostic factors such as age, Karnofsky performance score, MGMT-promoter methylation status and extent of resection.ResultsA total of 240 patients with newly diagnosed glioblastoma and subsequent surgical treatment were identified. 13 patients (5%) suffered from PMV during the treatment course of glioblastoma. All but one patient were successfully weaned from mechanical ventilation. Patients suffering from PMV achieved significantly less often favorable functional outcome after 3, 6, 9, and 12 months compared to patients without PMV. Multivariate analysis revealed PMV to constitute a significant prognostic factor for OS, independent of other prognostic factors (p<0.0001, OR 6.7, 95% CI 3.2–13.8).ConclusionsThe present study identifies PMV as significantly associated with impaired functional outcome and poor OS in patients suffering from newly diagnosed glioblastoma. These findings encourage further efforts to investigate/assess this prognostic factor in future studies.

show abstract

Surgery for temporal glioblastoma: lobectomy outranks oncosurgical-based gross-total resection

Cited by 34 publications

References 28 publications

Safety metric profiling in surgery for temporal glioblastoma: lobectomy as a supra-total resection regime preserves perioperative standard quality rates

Safety metric profiling in surgery for temporal glioblastoma: lobectomy as a supra-total resection regime preserves perioperative standard quality rates

Newly diagnosed glioblastoma in geriatric (65 +) patients: impact of patients frailty, comorbidity burden and obesity on overall survival

Postoperative Prolonged Mechanical Ventilation in Patients With Newly Diagnosed Glioblastoma—An Unrecognized Prognostic Factor

Contact Info

Product

Resources

About