Adam M Sonabend1, Brad E Zacharia2, Michael B Cloney1, Aarón Sonabend3, Christopher Showers1, Victoria Ebiana1, Matthew Nazarian1, Kristin R Swanson4, Anne Baldock5, Henry Brem6, Jeffrey N Bruce1, William Butler7, Daniel P Cahill7, Bob Carter8, Daniel A Orringer9, David W Roberts10, Oren Sagher9, Nader Sanai11, Theodore H Schwartz12, Daniel L Silbergeld13, Michael B Sisti1, Reid C Thompson14, Allen E Waziri15, Zoher Ghogawala16, Guy McKhann1. 1. Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York. 2. Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania. 3. Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. 4. Department of Neurological Surgery, Mayo Clinic, Scottsdale, Arizona. 5. University California at San Diego School of Medicine, San Diego, California. 6. Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 7. Department of Neurological Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 8. Division of Neurosurgery, Department of Surgery, University California at San Diego School of Medicine, San Diego, California. 9. Department of Neurological Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan. 10. Division of Neurosurgery, Dartmouth University, Lebanon, New Hampshire. 11. Division of Neurosurgical Oncology, Barrow Neurological Institute, Phoenix, Arizona. 12. Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York. 13. Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington. 14. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. 15. Inova Neuroscience Institute, Falls Church, Virginia. 16. Alan and Jacqueline Stuart Spine Research Center, Lahey Hospital and Medical Center, Burlington, Massachusetts.
Abstract
BACKGROUND: Extent of resection (EOR) correlates with glioblastoma outcomes. Resectability and EOR depend on anatomical, clinical, and surgeon factors. Resectability likely influences outcome in and of itself, but an accurate measurement of resectability remains elusive. An understanding of resectability and the factors that influence it may provide a means to control a confounder in clinical trials and provide reference for decision making. OBJECTIVE: To provide proof of concept of the use of the collective wisdom of experienced brain tumor surgeons in assessing glioblastoma resectability. METHODS: We surveyed 13 academic tumor neurosurgeons nationwide to assess the resectability of newly diagnosed glioblastoma. Participants reviewed 20 cases, including digital imaging and communications in medicine-formatted pre- and postoperative magnetic resonance images and clinical vignettes. The selected cases involved a variety of anatomical locations and a range of EOR. Participants were asked about surgical goal, eg, gross total resection, subtotal resection (STR), or biopsy, and rationale for their decision. We calculated a "resectability index" for each lesion by pooling responses from all 13 surgeons. RESULTS: Neurosurgeons' individual surgical goals varied significantly ( P = .015), but the resectability index calculated from the surgeons' pooled responses was strongly correlated with the percentage of contrast-enhancing residual tumor ( R = 0.817, P < .001). The collective STR goal predicted intraoperative decision of intentional STR documented on operative notes ( P < .01) and nonresectable residual ( P < .01), but not resectable residual. CONCLUSION: In this pilot study, we demonstrate the feasibility of measuring the resectability of glioblastoma through crowdsourcing. This tool could be used to quantify resectability, a potential confounder in neuro-oncology clinical trials.
BACKGROUND: Extent of resection (EOR) correlates with glioblastoma outcomes. Resectability and EOR depend on anatomical, clinical, and surgeon factors. Resectability likely influences outcome in and of itself, but an accurate measurement of resectability remains elusive. An understanding of resectability and the factors that influence it may provide a means to control a confounder in clinical trials and provide reference for decision making. OBJECTIVE: To provide proof of concept of the use of the collective wisdom of experienced brain tumor surgeons in assessing glioblastoma resectability. METHODS: We surveyed 13 academic tumor neurosurgeons nationwide to assess the resectability of newly diagnosed glioblastoma. Participants reviewed 20 cases, including digital imaging and communications in medicine-formatted pre- and postoperative magnetic resonance images and clinical vignettes. The selected cases involved a variety of anatomical locations and a range of EOR. Participants were asked about surgical goal, eg, gross total resection, subtotal resection (STR), or biopsy, and rationale for their decision. We calculated a "resectability index" for each lesion by pooling responses from all 13 surgeons. RESULTS: Neurosurgeons' individual surgical goals varied significantly ( P = .015), but the resectability index calculated from the surgeons' pooled responses was strongly correlated with the percentage of contrast-enhancing residual tumor ( R = 0.817, P < .001). The collective STR goal predicted intraoperative decision of intentional STR documented on operative notes ( P < .01) and nonresectable residual ( P < .01), but not resectable residual. CONCLUSION: In this pilot study, we demonstrate the feasibility of measuring the resectability of glioblastoma through crowdsourcing. This tool could be used to quantify resectability, a potential confounder in neuro-oncology clinical trials.
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