The Treatment of Glioblastoma Multiforme of the Brain

Jelsma, Richard K.; Bucy, Paul C.

doi:10.3171/jns.1967.27.5.0388

Cited by 217 publications

(84 citation statements)

References 5 publications

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“…The initial impetus for aggressive surgery was based on results from single-institution surgical series collected over a long period of time. [2,3,18,20,22,25,26,34,40,42] These retrospective reports showed a benefit of radical surgery on survival rates; however, the studies were prone to selection bias and failed to control for important characteristics including patient age and functional status and the tumor's location and histological characteristics, thereby rendering the studies' conclusions suspect. Further limitations on analysis of single-institution series are imposed by patterns of referral, incomplete follow-up information, and other missing data.…”

Section: Discussionmentioning

confidence: 95%

“…Although the need for tissue diagnosis and the efficacy of debulking tumor for relief of mass effect in symptomatic patients is universally accepted, the effect of aggressive cytoreductive surgery on patient survival time is unclear. Radical tumor extirpation is intuitively logical and recommended by most neurosurgeons who treat children and adults; [2,3,12,15,22,25,26,34,40,42,50,51] however, recent literature reviews, focusing primarily on adult patients, have failed to demonstrate a significant survival benefit of radical tumor resection. [10,30,35,41,44] Previous reports in which the influence of the extent of tumor resection on malignant astrocytomas has been examined have been retrospective studies in which the influence of other prognostic variables or the vagaries of surgical and perioperative management have not been consistently considered.…”

Section: Discussionmentioning

confidence: 99%

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Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children's Cancer Group Trial No. CCG-945

Wisoff

Boyett²,

Berger³

et al. 1998

FOC

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Object One hundred seventy-two children with high-grade astrocytomas were treated by members of the Children's Cancer Group in a prospective randomized trial designed to evaluate the role of two chemotherapy regimens. Seventy-six percent of the patients (131 children) in whom a diagnosis of either anaplastic astrocytoma or glioblastoma multiforme was confirmed by central pathological review are the subject of this report. Methods Patients were stratified according to the extent of tumor resection (biopsy [< 10%], partial resection [10-50%], subtotal resection [51-90%], near-total resection [> 90%], and total resection) as determined by surgical observation and postoperative computerized tomography scanning. Information on contemporary neurosurgical management was obtained from the patient's operative records and standardized neurosurgical report forms. The vast majority of tumors were supratentorial: 63% (83 tumors) in the superficial cerebral hemisphere, 28% (37 tumors) in the deep or midline cerebrum, and only 8% (11 tumors) in the posterior fossa. A significant association was detected between the primary tumor site and the extent of resection (p < 0.0001). A radical resection (> 90%) was performed in 37% of the children: 49% of the tumors in the superficial hematoma and 45% of tumors in the posterior fossa compared with 8% of midline tumors. Tumor location could also be used to predict the need for both temporary and permanent cerebrospinal fluid (CSF) diversion. Half of the deep tumors and 8% of the hemispheric astrocytomas ultimately required a permanent CSF shunt. Improvement in preoperative neurological deficits and level of consciousness was seen in 36% and 34% of the children, respectively. New or increased deficits were present in 14% of the children, with 6% experiencing a diminished sensorium after surgery. Postoperative nonneurological complications were rare, infection, embolization, and CFS fistula each occurring in 1.7% of the children. Univariate and multivariate analyses demonstrated that radical tumor resection (> 90%) was the only therapeutic variable that significantly improved progression-free survival (PFS) rates. For all patients with malignant astrocytomas, the distributions of PFS rates were significantly different (p = 0.006) following radical resection compared with less extensive (¾ 90%) resection. The 5-year PFS rates were 35 ± 7% and 17 ± 4%, respectively. The differences in the distribution of PFS rate were significantly different for the subsets of patients with anaplastic astrocytoma (p = 0.055) and glioblastoma multiforme (p = 0.046). The 5-year PFS rates for anaplastic astrocytoma were 44 ± 11% and 22 ± 6% for cases in which the tumor was radically resected and less than radically resected, respectively; whereas the 5-year PFS rates for glioblastoma multiforme were 26 ± 9% and 4 ± 3% for cases in which the tumor was radically resected and less than radically resected, respectively. Conclusions The demonstration of a survival advantage provided by radical resection should prompt neurosurgeons to treat malignant pediatric astrocytomas with aggressive surgical resection prior to initiation of radiotherapy or adjuvant chemotherapy.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children's Cancer Group Trial No. CCG-945

Wisoff

Boyett²,

Berger³

et al. 1998

FOC

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“…Considered in the present light, however, the patterns of their lobar and multilobar cases suggest that the major significant difference is the diffusion coefficient: low in those that remain relatively localized to the cortex and white matter (36 cases), higher in those that invade deep cerebral nuclei unilaterally (17 cases), still higher in those that cross the midline through the corpus callosum (10 cases) and highest in those that invade into the contralateral deep cerebral nuclei (15 cases). Matsukado et al (1961) estimated that the 36 relatively localized cases could have been cured by radical surgery but Jelsma and Bucy (1967) failed to cure any even with extensive resection approaching hemispherectomy. This fits with our conclusion that submicroscopic invasion had taken place.…”

Section: Discussionmentioning

confidence: 99%

Virtual brain tumours (gliomas) enhance the reality of medical imaging and highlight inadequacies of current therapy

2002

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Gliomas are brain tumours that differ from most other cancers by their diffuse invasion of the surrounding normal tissue and their notorious recurrence following all forms of therapy. We have developed a mathematical model to quantify the spatiotemporal growth and invasion of gliomas in three dimensions throughout a virtual human brain. The model quantifies the extent of tumorous invasion of individual gliomas in three-dimensions to a degree beyond the limits of present medical imaging, including even microscopy, and makes clear why current therapies based on existing imaging techniques are inadequate and cannot be otherwise without other methods for detecting tumour cells in the brain. The model's estimate of the extent of tumourous invasion beyond that defined by standard medical imaging can be useful in more accurately planning therapy regimes as well as predicting sites of potential recurrence without waiting for reemergence on follow-up imaging.

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“…The median survival for patients treated by surgery alone is less than 6 months, and fewer than 500 survive at 3 years Bloom, 1975). Postoperative radiotherapy marginally improves the results (Roth & Elvidge, 1960;Taveras et al, 1962;Hitchcock & Sato, 1964;Jelsma & Bucy, 1967;. The addition of chemotherapy with a nitrosourea to the postoperative radiotherapy improves survival further (BCNU Walker & Strike, 1979;Brisman et al, 1976;CCNU Hildebrand, 1979) though this is not confirmed in a smaller series with CCNU (Garrett et al, 1978).…”

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confidence: 99%

A randomized study of misonidazole and radiotherapy for grade 3 and 4 cerebral astrocytoma

Bleehen¹,

Wiltshire²,

Plowman³

et al. 1981

Br J Cancer

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The results are reported of a small clinical trial carried out to assess the potential value of the hypoxic cell radiosensitizer misonidazole in the radiation treatment of Grade 3 and 4 supratentorial astrocytomas. A total of 55 patients were randomly allocated to one of 3 treatment groups. No significant differences were seen between the median survivals of patients in the 2 control radiation groups and that of the third group in which oral misonidazole at a dose of 3 g/m2 preceded each of 4 weekly radiation doses. Possible reasons why no improvement was seen are discussed in detail.

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The Treatment of Glioblastoma Multiforme of the Brain

Cited by 217 publications

References 5 publications

Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children's Cancer Group Trial No. CCG-945

Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children's Cancer Group Trial No. CCG-945

Virtual brain tumours (gliomas) enhance the reality of medical imaging and highlight inadequacies of current therapy

A randomized study of misonidazole and radiotherapy for grade 3 and 4 cerebral astrocytoma

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