An extent of resection threshold for recurrent glioblastoma and its risk for neurological morbidity

Oppenlander, Mark E.; Wolf, Andrew B.; Snyder, Laura A.; Bina, Robert; Wilson, Jeffrey R.; Coons, Stephen W.; Ashby, Lynn S.; Brachman, David; Nakaji, Peter; Porter, Randall W.; Smith, Kris A.; Spetzler, Robert F.; Sanai, Nader

doi:10.3171/2013.12.jns13184

Cited by 219 publications

(113 citation statements)

References 32 publications

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“…To supplement this method, we also performed formal tumor volumetrics using manual segmentation, as is commonly reported in glioma tumor series. 17,20 These data are most often described as "percentage of tumor resection" and "volume of residual tumor." Using a volumetric method to determine EOR provides information about the volume of residual tumor and is particularly useful if GTR was not the intention of surgery.…”

Section: Extent Of Tumor Resectionmentioning

confidence: 99%

Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma

Zaidi

Awad

Bohl

et al. 2016

JNS

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abbreviatioNs CSF = cerebrospinal fluid; EOR = extent of tumor resection; GTR = gross-total resection; QOL = quality of life; STR = subtotal resection; TNTS = transnasal transsphenoidal. obJective The comparative efficacy of microscopic and fully endoscopic transsphenoidal surgery for pituitary adenomas has not been well studied despite the adoption of fully endoscopic surgery by many pituitary centers. The influence of surgeon experience has also not been examined in this setting. The authors therefore compared the extent of tumor resection (EOR) and the endocrine outcomes of 1 very experienced surgeon performing a microscopic transsphenoidal surgery technique with those of a less experienced surgeon using a fully endoscopic transsphenoidal surgery technique for resection of nonfunctioning pituitary adenomas in a concurrent series of patients. methods Post hoc analysis was conducted of a cohort of adult patients prospectively enrolled in a pituitary adenoma quality-of-life study between October 2011 and June 2014. Patients were followed up for 6 months after surgery. Patients were treated either by a less experienced surgeon (100 independent cases) who practices fully endoscopic surgery exclusively or by a very experienced surgeon (1800 independent cases) who practices microscopic surgery exclusively. Patient demographic characteristics, tumor characteristics, hypopituitarism, complications, and length of hospital stay were analyzed. Tumor volumes and EOR were determined by formal volumetric analysis involving manual segmentation of MR images performed before surgery and within 6 months after surgery. Logistic regression analysis was used to determine predictors of EOR. results Fifty-five patients underwent fully endoscopic transsphenoidal surgery, and 80 patients underwent fully microscopic transsphenoidal surgery. The baseline characteristics of the 2 treatment groups were well matched. EOR was similar between the endoscopic and microscopic groups, respectively, as estimated by gross-total resection rate (78.2% vs 81.3%, p = 0.67), percentage of tumor resected (99.2% vs 98.7%, p = 0.42), and volume of residual tumor (0.12 cm 3 vs 0.20 cm 3 , p = 0.41). Multivariate modeling suggested that preoperative tumor volume was the most important predictor of EOR (p = 0.001). No difference was found in the development of anterior gland dysfunction (p > 0.14), but there was a higher incidence of permanent posterior gland dysfunction in the microscopic group (p = 0.04). Combined rates of major complications and unplanned readmissions were lower in the endoscopic group (p = 0.02), but individual complications were not significantly different. coNclusioNs A less experienced surgeon using a fully endoscopic technique was able to achieve outcomes similar to those of a very experienced surgeon using a microscopic technique in a cohort of patients with nonfunctioning tumors smaller than 60 cm 3 . The study raises the provocative notion that certain advantages afforded by the fully endoscopic technique may impact the learning c...

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Section: Extent Of Tumor Resectionmentioning

confidence: 99%

Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma

Zaidi

Awad

Bohl

et al. 2016

JNS

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“…Although the consensus on the best treatment of recurrent disease is not as solid as with newly diagnosed disease, multiple retrospective studies support the excision of resectable recurrences. 17,19,28 However, with recurrent disease, issues of wound healing and the patient's functional status can hamper attempts of total resection. Moreover, recurrences often occur at sites close to functional or eloquent brain that were respected during the first surgery.…”

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confidence: 99%

Laser interstitial thermal therapy for newly diagnosed and recurrent glioblastoma

Thomas

Rao

Kew

et al. 2016

FOC

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OBJECTIVE Glioblastoma (GBM) is the most common and deadly malignant primary brain tumor. Better surgical therapies are needed for newly diagnosed GBMs that are difficult to resect and for GBMs that recur despite standard therapies. The authors reviewed their institutional experience of using laser interstitial thermal therapy (LITT) for the treatment of newly diagnosed or recurrent GBMs. METHODS This study reports on the pre-LITT characteristics and post-LITT outcomes of 8 patients with newly diagnosed GBMs and 13 patients with recurrent GBM who underwent LITT. RESULTS Compared with the group with recurrent GBMs, the patients with newly diagnosed GBMs who underwent LITT tended to be older (60.8 vs 48.9 years), harbored larger tumors (22.4 vs 14.6 cm3), and a greater proportion had IDH wild-type GBMs. In the newly diagnosed GBM group, the median progression-free survival and the median survival after the procedure were 2 months and 8 months, respectively, and no patient demonstrated radiographic shrinkage of the tumor on follow-up imaging. In the 13 patients with recurrent GBM, 5 demonstrated a response to LITT, with radiographic shrinkage of the tumor following ablation. The median progression-free survival was 5 months, and the median survival was greater than 7 months. CONCLUSIONS In carefully selected patients with recurrent GBM, LITT may be an effective alternative to surgery as a salvage treatment. Its role in the treatment of newly diagnosed unresectable GBMs is not established yet and requires further study.

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“…Following a study with 170 patients, Oppenlander et al 23 concluded that an extent of resection larger than 80% in repeated surgery suffices to increase patients' survival.…”

Section: Extent Of Resection At Reoperationmentioning

confidence: 99%

Performance of adjuvant treatment correlates with survival in reoperated glioblastomas

Zanovello

Malheiros

Stávale

et al. 2016

Arq. Neuro-Psiquiatr.

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Objective To analyze cases of recurrent glioblastoma subjected to reoperation at a Brazilian public healthcare service. Methods A total of 39 patients subjected to reoperation for recurrent glioblastoma at the Department of Neurosurgery, São Paulo Hospital, Federal University of São Paulo, from January 2000 to December 2013 were retrospectively analyzed. Results The median overall survival was 20 months (95% confidence interval – CI = 14.9–25.2), and the median survival after reoperation was 9.1 months (95%CI: 2.8–15.4). The performance of adjuvant treatment after the first operation was the single factor associated with overall survival on multivariate analysis (relative risk – RR = 0.3; 95%CI = 0.2–0.7); p = 0.005). Conclusion The length of survival of patients subjected to reoperation for glioblastoma at a Brazilian public healthcare service was similar to the length reported in the literature. Reoperation should be considered as a therapeutic option for selected patients.

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An extent of resection threshold for recurrent glioblastoma and its risk for neurological morbidity

Cited by 219 publications

References 32 publications

Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma

Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma

Laser interstitial thermal therapy for newly diagnosed and recurrent glioblastoma

Performance of adjuvant treatment correlates with survival in reoperated glioblastomas

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