Yoshua Esquenazi1, Elliott Friedman2, Zheyu Liu3, Jay-Jiguang Zhu1, Sigmund Hsu1, Nitin Tandon1. 1. Vivian L. Smith Department of Neurosurgery and Mischer Neuroscience Institute, Houston, Texas. 2. Department of Radiology, Medical School, University of Texas Health Science Center at Houston, Houston, Texas. 3. Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas.
Abstract
BACKGROUND: A substantial body of evidence suggests that cytoreductive surgery is a prerequisite to prolonging survival in patients with glioblastoma (GBM). OBJECTIVE: To evaluate the safety and impact of "supratotal" resections beyond the zone of enhancement seen on magnetic resonance imaging scans, using a subpial technique. METHODS: We retrospectively evaluated 86 consecutive patients with primary GBM, managed by the senior author, using a subpial resection technique with or without carmustine (BCNU) wafer implantation. Multivariate Cox proportional hazards regression was used to analyze clinical, radiological, and outcome variables. Overall impacts of extent of resection (EOR) and BCNU wafer placement were compared using Kaplan-Meier survival analysis. RESULTS: Mean patient age was 56 years. The median OS for the group was 18.1 months. Median OS for patients undergoing gross total, near-total, and subtotal resection were 54, 16.5, and 13.2 months, respectively. Patients undergoing near-total resection ( P = .05) or gross total resection ( P < .01) experienced statistically significant longer survival time than patients undergoing subtotal resection as well as patients undergoing ≥95% EOR ( P < .01) when compared to <95% EOR. The addition of BCNU wafers had no survival advantage. CONCLUSIONS: The subpial technique extends the resection beyond the contrast enhancement and is associated with an overall survival beyond that seen in similar series where resection of the enhancement portion is performed. The effect of supratotal resection on survival exceeded the effects of age, Karnofsky performance score, and tumor volume. A prospective study would help to quantify the impact of the subpial technique on quality of life and survival as compared to a traditional resection limited to the enhancing tumor.
BACKGROUND: A substantial body of evidence suggests that cytoreductive surgery is a prerequisite to prolonging survival in patients with glioblastoma (GBM). OBJECTIVE: To evaluate the safety and impact of "supratotal" resections beyond the zone of enhancement seen on magnetic resonance imaging scans, using a subpial technique. METHODS: We retrospectively evaluated 86 consecutive patients with primary GBM, managed by the senior author, using a subpial resection technique with or without carmustine (BCNU) wafer implantation. Multivariate Cox proportional hazards regression was used to analyze clinical, radiological, and outcome variables. Overall impacts of extent of resection (EOR) and BCNU wafer placement were compared using Kaplan-Meier survival analysis. RESULTS: Mean patient age was 56 years. The median OS for the group was 18.1 months. Median OS for patients undergoing gross total, near-total, and subtotal resection were 54, 16.5, and 13.2 months, respectively. Patients undergoing near-total resection ( P = .05) or gross total resection ( P < .01) experienced statistically significant longer survival time than patients undergoing subtotal resection as well as patients undergoing ≥95% EOR ( P < .01) when compared to <95% EOR. The addition of BCNU wafers had no survival advantage. CONCLUSIONS: The subpial technique extends the resection beyond the contrast enhancement and is associated with an overall survival beyond that seen in similar series where resection of the enhancement portion is performed. The effect of supratotal resection on survival exceeded the effects of age, Karnofsky performance score, and tumor volume. A prospective study would help to quantify the impact of the subpial technique on quality of life and survival as compared to a traditional resection limited to the enhancing tumor.
Authors: Christina Jackson; John Choi; Adham M Khalafallah; Carrie Price; Chetan Bettegowda; Michael Lim; Gary Gallia; Jon Weingart; Henry Brem; Debraj Mukherjee Journal: J Neurooncol Date: 2020-06-19 Impact factor: 4.130
Authors: Yoshua Esquenazi; Nelson Moussazadeh; Thomas W Link; Koos E Hovinga; Anne S Reiner; Natalie M DiStefano; Cameron Brennan; Philip Gutin; Viviane Tabar Journal: Neurosurgery Date: 2018-07-01 Impact factor: 4.654
Authors: Antonio Dono; Mark Amsbaugh; Magda Martir; Richard H Smilie; Roy F Riascos; Jay-Jiguang Zhu; Sigmund Hsu; Dong H Kim; Nitin Tandon; Leomar Y Ballester; Angel I Blanco; Yoshua Esquenazi Journal: J Neurooncol Date: 2021-01-25 Impact factor: 4.130