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Does Extent of Resection Impact Survival in Patients Bearing Glioblastoma?

Published online by Cambridge University Press:  02 December 2014

Nicolas Dea ,
Marie-Pierre Fournier-Gosselin ,
David Mathieu ,
Philippe Goffaux  and
David Fortin
Nicolas Dea
Affiliation:
Division of Neurosurgery and Neuro-oncology, Surgery Department, Université de Sherbrooke, Sherbrooke
Marie-Pierre Fournier-Gosselin
Affiliation:
Division of Neurosurgery, Surgery Department, Université de Montréal, Montréal, Quebec, Canada
David Mathieu
Affiliation:
Division of Neurosurgery and Neuro-oncology, Surgery Department, Université de Sherbrooke, Sherbrooke
Philippe Goffaux
Affiliation:
Division of Neurosurgery and Neuro-oncology, Surgery Department, Université de Sherbrooke, Sherbrooke
David Fortin*
Affiliation:
Division of Neurosurgery and Neuro-oncology, Surgery Department, Université de Sherbrooke, Sherbrooke
*
Université de Sherbrooke, Division of Neurosurgery and Neuro-oncology, 3001, 12th Avenue North, Sherbrooke, Quebec, J1H 5N4, Canada. Email: [email protected]
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Abstract

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Background:

The impact of malignant glioma resection on survival is still a matter of controversy. The lack of well-designed prospective studies as well as control of all factors in retrospective studies plays an important role in this debate. Amongst some of these uncontrolled factors, are the inclusion of different histological grades, the lack of objective methods to estimate the extent of resection and unspecified delays in post-operative imaging.

Methods:

We retrospectively reviewed 126 consecutive patients with glioblastoma, operated on by the senior authors at the Centre Hospitalier Universitaire de Sherbrooke, who met the following criteria: >18 years of age, newly diagnosed glioblastoma, pre-operative magnetic resonance imaging (MRI) within 2 weeks prior to surgery, and a post-operative MRI within 72 hours after surgery. Extent of tumour resection was calculated using pre and post-operative tumour delimitation on gadolinium-enhanced T1 MRI in a volumetric analysis.

Results:

Applying stringent specific inclusion criteria, 126 patients were retained in the analysis. The median overall survival was 271 days and the median extent of resection was 65%. Patients with more than 90% of tumour resection had a significantly better outcome, improving median survival from 225 to 519 days (P=0.006). Other factors that significantly improved survival were the use of radiotherapy, the number of regimens and type of chemotherapy used.

Conclusion:

A more aggressive approach combining maximal safe resection and use of salvage chemotherapy seems to confer a survival advantage for glioblastoma patients.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 5 , September 2012 , pp. 632 - 637
Copyright
Copyright © The Canadian Journal of Neurological 2012

References

1.Stupp, R, Mason, WP, van den Bent, MJ, et al.Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987–96.Google Scholar
2.Dandy, W.Physiological studies following extirpation of right cerebral hemisphere in man. Bull Johns Hopkins Hosp. 1933;33: 31–51.Google Scholar
3.Hosli, P, Sappino, AP, de Tribolet, N, Dietrich, PY.Malignant glioma: should chemotherapy be overthrown by experimental treatments? Ann Oncol. 1998;9:589–600.Google Scholar
4.Mason, WP, Maestro, RD, Eisenstat, D, et al.Canadian recommendations for the treatment of glioblastoma multiforme. Curr Oncol. 2007;14:110–17.Google Scholar
5.Sanai, N, Berger, MS.Glioma extent of resection and its impact on patient outcome. Neurosurgery. 2008;62:753–64.Google Scholar
6.Hart, MG, Grant, R, Garside, R, Rogers, G, Somerville, M, Stein, K.Temozolomide for high grade glioma.Cochrane Database Syst. Rev. 2008;CD007415.Google Scholar
7.Hesson, LB, Krex, D, Latif, F.Epigenetic markers in human gliomas: prospects for therapeutic intervention. Expert Rev Neurother. 2008;8:1475–96.Google Scholar
8.Schneider, JP, Trantakis, C, Rubach, M, et al.Intraoperative MRI to guide the resection of primary supratentorial glioblastoma multiforme - a quantitative radiological analysis. Neuroradiology. 2005;47:489–500.Google Scholar
9.Lacroix, M, Abi-Said, D, Fourney, DR, et al.A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 2001;95:190–8.Google Scholar
10.Albert, FK, Forsting, M, Sartor, K, Adams, HP, Kunze, S.Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumour and its influence on regrowth and prognosis. Neurosurgery. 1994;34:45–60.Google Scholar
11.Henegar, MM, Moran, CJ, Silbergeld, DL.Early postoperative magnetic resonance imaging following nonneoplastic cortical resection. J Neurosurg. 1996;84:174–9.Google Scholar
12.Ekinci, G, Akpinar, IN, Baltacioglu, F, et al.Early-postoperative magnetic resonance imaging in glial tumours: prediction of tumour regrowth and recurrence. Eur J Radiol. 2003;45:99–107.Google Scholar
13.Keles, GE, Anderson, B, Berger, MS.The effect of extent of resection on time to tumour progression and survival in patients with glioblastoma multiforme of the cerebral hemisphere. Surg Neurol. 1999;52:371–9.Google Scholar
14.Keles, GE, Chang, EF, Lamborn, KR, et al.Volumetric extent of resection and residual contrast enhancement on initial surgery as predictors of outcome in adult patients with hemispheric anaplastic astrocytoma. J Neurosurg. 2006;105:34–40.Google Scholar
15.Pope, WB, Sayre, J, Perlina, A, Villablanca, JP, Mischel, PS, Cloughesy, TF.MR imaging correlates of survival in patients with high-grade gliomas. AJNR Am J Neuroradiol. 2005;26:2466–74.Google ScholarPubMed
16.McGirt, MJ, Chaichana, KL, Gathinji, M, et al.Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg. 2009;110:156–62.CrossRefGoogle ScholarPubMed
17.Gutin, PH, Posner, JB.Neuro-oncology: diagnosis and management of cerebral gliomas-past, present, and future. Neurosurgery. 2000;47:1–8.Google Scholar
18.Fortin, D.Altering the properties of the blood-brain barrier: disruption and permeabilization. Prog Drug Res. 2003;61:125–54.Google ScholarPubMed
19.Fortin, D, Desjardins, A, Benko, A, Niyonsega, T, Boudrias, M.Enhanced chemotherapy delivery by intraarterial infusion and blood-brain barrier disruption in malignant brain tumours: the Sherbrooke experience. Cancer. 2005;103:2606–15.Google Scholar
20.Walker, MD.The contemporary role of chemotherapy in the treatment of malignant brain tumour. Clin Neurosurg. 1978;25:388–96.Google Scholar