Long Di1, Rainya N Heath2, Ashish H Shah2, Alexander D Sanjurjo2, Daniel G Eichberg2, Evan M Luther2, Macarena I de la Fuente3,4, Ricardo J Komotar2,4, Michael E Ivan2,4. 1. Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terr, Miami, FL, 33136, USA. Longdi1996@gmail.com. 2. Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terr, Miami, FL, 33136, USA. 3. Department of Neurology, University of Miami School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA. 4. Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL, 33136, USA.
Abstract
OBJECT: Diffuse tumor invasion in multifocal/multicentric GBM (mGBM) often foreshadows poor survival outcome. The correlation between extent of resection in gliomas and patient outcome is well described. The objective of this study was to assess the effect of gross total resection compared to biopsy for mGBM on patient overall survival and progression free survival. METHODS: Thirty-four patients with mGBM received either biopsy or resection of their largest enhancing lesion from 2011 to 2019. Relevant demographic, peri-operative, and radiographic data were collected. Tumor burden and extent of resection was assessed through measurement of pre-operative and post-operative contrast-enhancing volume. An adjusted Kaplan-Meier survival analysis was conducted using inverse probability of treatment weighting (IPTW) to account for the covariates of age, number of lesions, satellite tumor volume, total pre-operative tumor volume, degree of spread, and location. RESULTS: Thirty-four patients were identified with sixteen (47.1%) and eighteen (52.9%) patients receiving resection and biopsy respectively. Patients receiving resection exhibited greater median overall survival but not progression free survival compared to biopsy on IPTW analysis (p = 0.026, p = 0.411). Greater than or equal to 85% extent of resection was significantly associated with increased median overall survival (p = 0.016). CONCLUSION: Overall, our study suggests that resection of the largest contrast-enhancing lesion may provide a survival benefit. Our volumetric analysis suggests that a greater degree of resection results in improved survival. Employing IPTW analysis, we sought to control for selection bias in our retrospective analysis. Thus, aggressive surgical treatment of mGBM may offer improved outcomes. Further clinical trials are needed.
OBJECT: Diffuse tumor invasion in multifocal/multicentric GBM (mGBM) often foreshadows poor survival outcome. The correlation between extent of resection in gliomas and patient outcome is well described. The objective of this study was to assess the effect of gross total resection compared to biopsy for mGBM on patient overall survival and progression free survival. METHODS: Thirty-four patients with mGBM received either biopsy or resection of their largest enhancing lesion from 2011 to 2019. Relevant demographic, peri-operative, and radiographic data were collected. Tumor burden and extent of resection was assessed through measurement of pre-operative and post-operative contrast-enhancing volume. An adjusted Kaplan-Meier survival analysis was conducted using inverse probability of treatment weighting (IPTW) to account for the covariates of age, number of lesions, satellite tumor volume, total pre-operative tumor volume, degree of spread, and location. RESULTS: Thirty-four patients were identified with sixteen (47.1%) and eighteen (52.9%) patients receiving resection and biopsy respectively. Patients receiving resection exhibited greater median overall survival but not progression free survival compared to biopsy on IPTW analysis (p = 0.026, p = 0.411). Greater than or equal to 85% extent of resection was significantly associated with increased median overall survival (p = 0.016). CONCLUSION: Overall, our study suggests that resection of the largest contrast-enhancing lesion may provide a survival benefit. Our volumetric analysis suggests that a greater degree of resection results in improved survival. Employing IPTW analysis, we sought to control for selection bias in our retrospective analysis. Thus, aggressive surgical treatment of mGBM may offer improved outcomes. Further clinical trials are needed.
Entities:
Keywords:
Brain tumor; Extent of resection; Glioblastoma; Multifocal; Outcomes
Authors: Francesco Bruno; Alessia Pellerino; Edoardo Pronello; Rosa Palmiero; Luca Bertero; Cristina Mantovani; Andrea Bianconi; Antonio Melcarne; Diego Garbossa; Roberta Rudà Journal: Brain Sci Date: 2022-05-11
Authors: John F de Groot; Albert H Kim; Sujit Prabhu; Ganesh Rao; Adrian W Laxton; Peter E Fecci; Barbara J O'Brien; Andrew Sloan; Veronica Chiang; Stephen B Tatter; Alireza M Mohammadi; Dimitris G Placantonakis; Roy E Strowd; Clark Chen; Constantinos Hadjipanayis; Mustafa Khasraw; David Sun; David Piccioni; Kaylyn D Sinicrope; Jian L Campian; Sylvia C Kurz; Brian Williams; Kris Smith; Zulma Tovar-Spinoza; Eric C Leuthardt Journal: Neurooncol Adv Date: 2022-04-06
Authors: Johannes Kasper; Nicole Hilbert; Tim Wende; Michael Karl Fehrenbach; Florian Wilhelmy; Katja Jähne; Clara Frydrychowicz; Gordian Hamerla; Jürgen Meixensberger; Felix Arlt Journal: Curr Oncol Date: 2021-04-07 Impact factor: 3.677