Association of Surgical Resection, Disability, and Survival in Patients with Glioblastoma

Ahmadipour, Yahya; Kaur, Monika; Pierscianek, Daniela; Gembruch, Oliver; Oppong, Marvin Darkwah; Mueller, Oliver; Jabbarli, Ramazan; Glas, Martin; Sure, Ulrich; Hindy, Nicolai El

doi:10.1055/s-0039-1685170

Cited by 18 publications

(14 citation statements)

References 31 publications

(34 reference statements)

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“…For example, the extent of resection of the enhancing part of a glioblastoma correlates with the survival time of the patients. [2][3][4][5] Unfortunately, conventional MRI tends to underestimate the extent of diffuse infiltrative glioma growth, as the infiltrating cells' spread exceeds the enhancing part of the tumor. 6,7 It is known that glioma cells migrate into the tumor edema, which appears hyperintense on T2-weighted (T2w) and FLAIR images, or even beyond.…”

Section: Introductionmentioning

confidence: 99%

“…Apart from the diagnostic value, identification of tumor regions enhancing after CA administration has implications for treatment. For example, the extent of resection of the enhancing part of a glioblastoma correlates with the survival time of the patients . Unfortunately, conventional MRI tends to underestimate the extent of diffuse infiltrative glioma growth, as the infiltrating cells' spread exceeds the enhancing part of the tumor .…”

Section: Introductionmentioning

confidence: 99%

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Quantitative T1 mapping indicates tumor infiltration beyond the enhancing part of glioblastomas

et al. 2019

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The aim of this study was to evaluate whether maps of quantitative T1 (qT1) differences induced by a gadolinium-based contrast agent (CA) are better suited than conventional T1-weighted (T1w) MR images for detecting infiltration inside and beyond the peritumoral edema of glioblastomas. Conventional T1w images and qT1 maps were obtained before and after gadolinium-based CA administration in 33 patients with glioblastoma before therapy. The following data were calculated: (i) absolute qT1-difference maps (qT1 pre-CA -qT1 post-CA), (ii) relative qT1-difference maps, (iii) absolute and (iv) relative differences of conventional T1w images acquired preand post-CA. The values of these four datasets were compared in four different regions: (a) the enhancing tumor, (b) the peritumoral edema, (c) a 5 mm zone around the pathology (defined as the sum of regions a and b), and (d) the contralateral normal appearing brain tissue. Additionally, absolute qT1-difference maps (displayed with linear gray scaling) were visually compared with respective conventional difference images. The enhancing tumor was visible both in the difference of conventional preand post-CA T1w images and in the absolute qT1-difference maps, whereas only the latter showed elevated values in the peritumoral edema and in some cases even beyond. Mean absolute qT1-difference values were significantly higher (P < 0.01) in the enhancing tumor (838 ± 210 ms), the peritumoral edema (123 ± 74 ms) and in the 5 mm zone around the pathology (81 ± 31 ms) than in normal appearing tissue (32 ± 35 ms). In summary, absolute qT1-difference maps-in contrast to the difference of T1w images-of untreated glioblastomas appear to be able to visualize CA leakage, and thus might indicate tumor cell infiltration in the edema region and beyond. Therefore, the absolute qT1-difference maps are potentially useful for treatment planning. K E Y W O R D Sgadolinium-based contrast agent, glioblastoma, infiltration, longitudinal relaxation time T1, quantitative MRI, quantitative T1-difference maps, edema

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quantitative T1 mapping indicates tumor infiltration beyond the enhancing part of glioblastomas

et al. 2019

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“…In the study of Ahmadipour et al, the HR of biopsy compared with total resection was 2.33 (95%CI 1.77-3.06) for death. 17 Therefore, we calculated a sample size of 26 patients per group at 80% power and with an α level of 0.05, using the Freedman method. 18 Propensity score regression adjustment was used to run the outcome model of the association between EOR and survival controlled by PS and posttreatment variables from the unmatched dataset.…”

Section: Discussionmentioning

confidence: 99%

Effect of the Extent of Resection on Survival Outcome in Glioblastoma: Propensity Score Approach

Tunthanathip

Madteng

2020

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Objective To evaluate the effectiveness of the extent of resection (EOR) on survival outcome using propensity score-based approaches. Materials and Methods A retrospective cohort study was performed in patients with newly diagnosed glioblastoma. Propensity score matching (PSM) and propensity score regression adjustment were used in the matched and unmatched dataset, respectively. Therefore, the Kaplan-Meier survival curve and Cox's regression analyses were performed to determine the effect of the EOR on survival outcomes. Results One hundred and sixty-eight patients were included for analyzes. The total tumor resection in the unmatched dataset was 22.6% of all cases. Using PSM, incomplete tumor resection had an unfavorable survival outcome when compared with total tumor resection (hazard ratio (HR) 2.92, 95% confidence interval [CI] 1.72–4.94). Additionally, biopsy and partial tumor resection were significantly associated with poor prognosis when compared with total tumor resection using propensity score regression adjustment (HR of biopsy 1.89, 95%CI 1.13–3.16 and HR of partial resection 1.89, 95%CI 1.28–2.80). Conclusions Patients with total tumor resection tend to have a more favorable prognosis than patients with partial tumor resection. The propensity score-based analysis is an alternative approach to evaluate the effect of an intervention that has limitations to perform a randomized controlled trial.

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“…In many of these cases, in fact, Temozolomide is given as single treatment. Withdrawal of radiation may also contribute to the poor prognosis associated with multifocal glioblastoma [40,41].…”

Section: Multifocal Glioblastomamentioning

confidence: 99%

Location of Glioblastoma and its Significance in Response to Treatment

Paldor

Sviri

2019

ANN

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Basal ganglia and thalamus glioblastomaDeep seated glioblastoma -tumors in the basal ganglia, insula and thalamus, have been shown to carry a worse prognosis as compared to glioblastoma in other locations [22,28,29]. However, extent of resection, a known predictor of outcome in glioblastoma, has also been shown to be significantly lower in deep seated glioblastomas [30][31][32][33]. It is unclear whether the worse prognosis is merely a representation of the lesser extent of resection or an actual survival difference. There has been no direct assessment of This work is licensed under Creative Commons Attribution 4.0 License ANN.MS.ID.000613.

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Association of Surgical Resection, Disability, and Survival in Patients with Glioblastoma

Cited by 18 publications

References 31 publications

Quantitative T1 mapping indicates tumor infiltration beyond the enhancing part of glioblastomas

Quantitative T1 mapping indicates tumor infiltration beyond the enhancing part of glioblastomas

Effect of the Extent of Resection on Survival Outcome in Glioblastoma: Propensity Score Approach

Location of Glioblastoma and its Significance in Response to Treatment

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