Stefanie Bette1, Melanie Barz2, Benedikt Wiestler1, Thomas Huber3, Julia Gerhardt2, Niels Buchmann2, Stephanie E Combs4,5,6, Friederike Schmidt-Graf7, Claire Delbridge8, Claus Zimmer1, Jan S Kirschke1, Bernhard Meyer2, Yu-Mi Ryang2, Florian Ringel2, Jens Gempt9. 1. Department of Neuroradiology, Klinikum rechts der Isar der Technischen Universitat, Munich, Germany. 2. Department of Neurosurgery, Klinikum rechts der Isar der Technischen Universitat, Munich, Germany. 3. Department of Radiology, Ludwig-Maximilians-University, Munich, Germany. 4. Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universitat, Munich, Germany. 5. Institute for Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, 85764, Oberschleißheim, Germany. 6. Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany. 7. Department of Neurology, Klinikum rechts der Isar der Technischen Universitat, Munich, Germany. 8. Department of Neuropathology, Klinikum rechts der Isar der Technischen Universitat, Munich, Germany. 9. Department of Neurosurgery, Klinikum rechts der Isar der Technischen Universitat, Munich, Germany. jens.gempt@tum.de.
Abstract
BACKGROUND: Incomplete resection of glioblastoma is discussed controversially in the era of combined radiochemotherapy. OBJECTIVE: The aim of this study was to analyze the benefit of subtotal tumor resection for glioblastoma patients as this was recently questioned in the era of radiochemotherapy. METHODS: Overall, 209 patients undergoing surgery for newly diagnosed WHO grade IV gliomas were retrospectively analyzed, and pre- and postoperative tumor volumes were manually segmented (cm3). Survival analyses were performed, including prognostic factors such as age, Karnofsky performance score (KPS), O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation status, and adjuvant treatment regimen. RESULTS: Pre- and postoperative tumor volume is significantly associated with pre- and postoperative KPS, as well as age (p < 0.001). Postoperative tumor volume remained a significant prognostic factor in a multivariate analysis, independent of other prognostic factors (hazard ratio 1.0365, 95% confidence interval 1.0235-1.0497, p < 0.001). CONCLUSIONS: In the era of molecularly-driven radiochemotherapy, glioblastoma surgery remains a major prognostic factor. Even in situations in which a gross total resection cannot be achieved, maximum safe reduction of tumor burden should be attempted.
BACKGROUND: Incomplete resection of glioblastoma is discussed controversially in the era of combined radiochemotherapy. OBJECTIVE: The aim of this study was to analyze the benefit of subtotal tumor resection for glioblastomapatients as this was recently questioned in the era of radiochemotherapy. METHODS: Overall, 209 patients undergoing surgery for newly diagnosed WHO grade IV gliomas were retrospectively analyzed, and pre- and postoperative tumor volumes were manually segmented (cm3). Survival analyses were performed, including prognostic factors such as age, Karnofsky performance score (KPS), O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation status, and adjuvant treatment regimen. RESULTS: Pre- and postoperative tumor volume is significantly associated with pre- and postoperative KPS, as well as age (p < 0.001). Postoperative tumor volume remained a significant prognostic factor in a multivariate analysis, independent of other prognostic factors (hazard ratio 1.0365, 95% confidence interval 1.0235-1.0497, p < 0.001). CONCLUSIONS: In the era of molecularly-driven radiochemotherapy, glioblastoma surgery remains a major prognostic factor. Even in situations in which a gross total resection cannot be achieved, maximum safe reduction of tumor burden should be attempted.
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Authors: Hui K Gan; Sagun Parakh; Andrew B Lassman; Aidan Seow; Eddie Lau; Sze Ting Lee; Malaka Ameratunga; Yuliya Perchyonok; Diana Cao; Ingrid J G Burvenich; Graeme J O'Keefe; Angela Rigopoulos; Erica Gomez; David Maag; Andrew M Scott Journal: Neurooncol Adv Date: 2021-08-03