Ruichong Ma1, Aswin Chari2,3, Paul M Brennan4, Andrew Alalade5, Ian Anderson6, Anna Solth7, Hani J Marcus8, Colin Watts9. 1. Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, UK. 2. Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK. 3. Department of Neurosurgery, Royal London Hospital, London, UK. 4. Department of Neurosurgery, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh. 5. Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. 6. Department of Neurosurgery, Leeds General Infirmary, Leeds, UK. 7. Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK. 8. Department of Neurosurgery, Charing Cross Hospital, London, UK. 9. Department of Neurosurgery, Addenbrookes Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
Abstract
BACKGROUND: A growing body of clinical data highlights the prognostic importance of achieving gross total resection (GTR) in patients with glioblastoma. The aim of this study was to determine nationwide practice and attitudes towards achieving GTR and dealing with residual enhancing disease. METHODS: The study was in 2 parts: an electronic questionnaire sent to United Kingdom neuro-oncology surgeons to assess surgical practice followed by a 3-month prospective, multicenter observational study of current neurosurgical oncology practice. RESULTS: Twenty-seven surgeons representing 22 neurosurgical units completed the questionnaire. Prospective data were collected for 113 patients from 15 neurosurgical units. GTR was deemed to be achieved at time of surgery in 82% (91/111) of cases, but in only 45% (36/80) on postoperative MRI. Residual enhancing disease was deemed operable in 16.3% (13/80) of cases, however, no patient underwent early repeat surgery for residual enhancing disease. The most commonly cited reason (38.5%, 5/13) was perceived lack of clinical benefit. CONCLUSION: There is a subset of patients for whom GTR is thought possible, but not achieved at surgery. For these patients, early repeat resection may improve overall survival. Further prospective surgical research is required to better define the prognostic implications of GTR for residual enhancing disease and examine the potential benefit of this early re-intervention.
BACKGROUND: A growing body of clinical data highlights the prognostic importance of achieving gross total resection (GTR) in patients with glioblastoma. The aim of this study was to determine nationwide practice and attitudes towards achieving GTR and dealing with residual enhancing disease. METHODS: The study was in 2 parts: an electronic questionnaire sent to United Kingdom neuro-oncology surgeons to assess surgical practice followed by a 3-month prospective, multicenter observational study of current neurosurgical oncology practice. RESULTS: Twenty-seven surgeons representing 22 neurosurgical units completed the questionnaire. Prospective data were collected for 113 patients from 15 neurosurgical units. GTR was deemed to be achieved at time of surgery in 82% (91/111) of cases, but in only 45% (36/80) on postoperative MRI. Residual enhancing disease was deemed operable in 16.3% (13/80) of cases, however, no patient underwent early repeat surgery for residual enhancing disease. The most commonly cited reason (38.5%, 5/13) was perceived lack of clinical benefit. CONCLUSION: There is a subset of patients for whom GTR is thought possible, but not achieved at surgery. For these patients, early repeat resection may improve overall survival. Further prospective surgical research is required to better define the prognostic implications of GTR for residual enhancing disease and examine the potential benefit of this early re-intervention.
Authors: Whitney B Pope; James Sayre; Alla Perlina; J Pablo Villablanca; Paul S Mischel; Timothy F Cloughesy Journal: AJNR Am J Neuroradiol Date: 2005 Nov-Dec Impact factor: 3.825
Authors: M Lacroix; D Abi-Said; D R Fourney; Z L Gokaslan; W Shi; F DeMonte; F F Lang; I E McCutcheon; S J Hassenbusch; E Holland; K Hess; C Michael; D Miller; R Sawaya Journal: J Neurosurg Date: 2001-08 Impact factor: 5.115
Authors: Roger Stupp; Warren P Mason; Martin J van den Bent; Michael Weller; Barbara Fisher; Martin J B Taphoorn; Karl Belanger; Alba A Brandes; Christine Marosi; Ulrich Bogdahn; Jürgen Curschmann; Robert C Janzer; Samuel K Ludwin; Thierry Gorlia; Anouk Allgeier; Denis Lacombe; J Gregory Cairncross; Elizabeth Eisenhauer; René O Mirimanoff Journal: N Engl J Med Date: 2005-03-10 Impact factor: 91.245
Authors: T L Phillips; V A Levin; D K Ahn; P H Gutin; R L Davis; C B Wilson; M D Prados; W M Wara; M S Flam Journal: Int J Radiat Oncol Biol Phys Date: 1991-08 Impact factor: 7.038