TY - JOUR
T1 - Extending the resection beyond the contrast-enhancement for glioblastoma
T2 - feasibility, efficacy, and outcomes
AU - Mampre, David
AU - Ehresman, Jeffrey
AU - Pinilla-Monsalve, Gabriel
AU - Osorio, Maria Alejandra Gamboa
AU - Olivi, Alessandro
AU - Quinones-Hinojosa, Alfredo
AU - Chaichana, Kaisorn L.
N1 - Publisher Copyright:
© 2018, © 2018 The Neurosurgical Foundation.
PY - 2018/9/3
Y1 - 2018/9/3
N2 - Object: It is becoming well-established that increasing extent of resection with decreasing residual volume is associated with delayed recurrence and prolonged survival for patients with glioblastoma (GBM). These prior studies are based on evaluating the contrast-enhancing (CE) tumour and not the surrounding fluid attenuated inversion recovery (FLAIR) volume. It therefore remains unclear if the resection beyond the CE portion of the tumour if it translates into improved outcomes for patients with GBM. Methods: Adult patients who underwent resection of a primary glioblastoma at a tertiary care institution between January 1, 2007 and December 31, 2012 and underwent radiation and temozolomide chemotherapy were retrospectively reviewed. Pre and postoperative MRI images were measured for CE tumour and FLAIR volumes. Multivariate proportional hazards were used to assess associations with both time to recurrence and death. Values with p < 0.05 were considered statistically significant. Results: 245 patients met the inclusion criteria. The median [IQR] preoperative CE and FLAIR tumour volumes were 31.9 [13.9–56.1] cm3 and 78.3 [44.7–115.6] cm3, respectively. Following surgery, the median [IQR] postoperative CE and FLAIR tumour volumes were 1.9 [0–7.1] cm3 and 59.7 [29.7–94.2] cm3, respectively. In multivariate analyses, the postoperative FLAIR volume was not associated with recurrence and/or survival (p > 0.05). However, the postoperative CE tumour volume was significantly associated with both recurrence [HR (95%CI); 1.026 (1.005–1.048), p= 0.01] and survival [HR (95%CI); 1.027 (1.007–1.032), p= 0.001]. The postoperative FLAIR volume was also not associated with recurrence and/or survival among patients who underwent gross total resection of the CE portion of the tumour as well as those who underwent supratotal resection. Conclusions: In this study, the volume of CE tumour remaining after resection is more important than FLAIR volume in regards to recurrence and survival for patients with GBM.
AB - Object: It is becoming well-established that increasing extent of resection with decreasing residual volume is associated with delayed recurrence and prolonged survival for patients with glioblastoma (GBM). These prior studies are based on evaluating the contrast-enhancing (CE) tumour and not the surrounding fluid attenuated inversion recovery (FLAIR) volume. It therefore remains unclear if the resection beyond the CE portion of the tumour if it translates into improved outcomes for patients with GBM. Methods: Adult patients who underwent resection of a primary glioblastoma at a tertiary care institution between January 1, 2007 and December 31, 2012 and underwent radiation and temozolomide chemotherapy were retrospectively reviewed. Pre and postoperative MRI images were measured for CE tumour and FLAIR volumes. Multivariate proportional hazards were used to assess associations with both time to recurrence and death. Values with p < 0.05 were considered statistically significant. Results: 245 patients met the inclusion criteria. The median [IQR] preoperative CE and FLAIR tumour volumes were 31.9 [13.9–56.1] cm3 and 78.3 [44.7–115.6] cm3, respectively. Following surgery, the median [IQR] postoperative CE and FLAIR tumour volumes were 1.9 [0–7.1] cm3 and 59.7 [29.7–94.2] cm3, respectively. In multivariate analyses, the postoperative FLAIR volume was not associated with recurrence and/or survival (p > 0.05). However, the postoperative CE tumour volume was significantly associated with both recurrence [HR (95%CI); 1.026 (1.005–1.048), p= 0.01] and survival [HR (95%CI); 1.027 (1.007–1.032), p= 0.001]. The postoperative FLAIR volume was also not associated with recurrence and/or survival among patients who underwent gross total resection of the CE portion of the tumour as well as those who underwent supratotal resection. Conclusions: In this study, the volume of CE tumour remaining after resection is more important than FLAIR volume in regards to recurrence and survival for patients with GBM.
KW - FLAIR volume
KW - extent of resection
KW - glioblastomas
KW - supratotal resection
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U2 - 10.1080/02688697.2018.1498450
DO - 10.1080/02688697.2018.1498450
M3 - Article
C2 - 30073866
AN - SCOPUS:85052088597
SN - 0268-8697
VL - 32
SP - 528
EP - 535
JO - British Journal of Neurosurgery
JF - British Journal of Neurosurgery
IS - 5
ER -