Biopsy versus partial versus gross total resection in older patients with high-grade glioma: a systematic review and meta-analysis

Almenawer, Saleh A.; Badhiwala, Jetan H.; Alhazzani, Waleed; Greenspoon, Jeffrey; Farrokhyar, Forough; Yarascavitch, Blake; Algird, Almunder; Kachur, Edward; Cenic, Aleksa; Sharieff, Waseem; Klurfan, Paula; Gunnarsson, Þorsteinn; Ajani, Olufemi; Reddy, Kesava; Singh, Sheila K.; Murty, Naresh K.

doi:10.1093/neuonc/nou349

Cited by 140 publications

(119 citation statements)

References 80 publications

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“…The currently available data suggest that surgical resection may play an important role [32, 33]. Adjuvant therapy is still a subject of investigation.…”

Section: Discussionmentioning

confidence: 99%

Current status and perspectives of interventional clinical trials for glioblastoma – analysis of ClinicalTrials.gov

et al. 2017

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The records of 208.777 (100%) clinical trials registered at ClinicalTrials.gov were downloaded on the 19th of February 2016. Phase II and III trials including patients with glioblastoma were selected for further classification and analysis. Based on the disease settings, trials were classified into three groups: newly diagnosed glioblastoma, recurrent disease and trials with no differentiation according to disease setting. Furthermore, we categorized trials according to the experimental interventions, the primary sponsor, the source of financial support and trial design elements. Trends were evaluated using the autoregressive integrated moving average model. Two hundred sixteen (0.1%) trials were selected for further analysis. Academic centers (investigator initiated trials) were recorded as primary sponsors in 56.9% of trials, followed by industry 25.9%. Industry was the leading source of monetary support for the selected trials in 44.4%, followed by 25% of trials with primarily academic financial support. The number of newly initiated trials between 2005 and 2015 shows a positive trend, mainly through an increase in phase II trials, whereas phase III trials show a negative trend. The vast majority of trials evaluate forms of different systemic treatments (91.2%). In total, one hundred different molecular entities or biologicals were identified. Of those, 60% were involving drugs specifically designed for central nervous system malignancies. Trials that specifically address radiotherapy, surgery, imaging and other therapeutic or diagnostic methods appear to be rare. Current research in glioblastoma is mainly driven or sponsored by industry, academic medical oncologists and neuro-oncologists, with the majority of trials evaluating forms of systemic therapies. Few trials reach phase III. Imaging, radiation therapy and surgical procedures are underrepresented in current trials portfolios. Optimization in research portfolio for glioblastoma is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-016-0740-5) contains supplementary material, which is available to authorized users.

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“…The currently available data suggest that surgical resection may play an important role [32, 33]. Adjuvant therapy is still a subject of investigation.…”

Section: Discussionmentioning

confidence: 99%

Current status and perspectives of interventional clinical trials for glioblastoma – analysis of ClinicalTrials.gov

et al. 2017

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“…Several prognostic factors for better outcomes in glioma patients have been reported, which include age, genetic mutations, achievement of gross total resection (GTR)3456. Among these factors, achievement of GTR was found to be crucial for the better prognosis78910. Incomplete resection, even in low grade gliomas, leads to higher probability of recurrence and shorter survival by residual tumor1112.…”

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confidence: 99%

Terahertz reflectometry imaging for low and high grade gliomas

Kang

et al. 2016

Sci Rep

100

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Gross total resection (GTR) of glioma is critical for improving the survival rate of glioma patients. One of the greatest challenges for achieving GTR is the difficulty in discriminating low grade tumor or peritumor regions that have an intact blood brain barrier (BBB) from normal brain tissues and delineating glioma margins during surgery. Here we present a highly sensitive, label-free terahertz reflectometry imaging (TRI) that overcomes current key limitations for intraoperative detection of World Health Organization (WHO) grade II (low grade), and grade III and IV (high grade) gliomas. We demonstrate that TRI provides tumor discrimination and delineation of tumor margins in brain tissues with high sensitivity on the basis of Hematoxylin and eosin (H&E) stained image. TRI may help neurosurgeons to remove gliomas completely by providing visualization of tumor margins in WHO grade II, III, and IV gliomas without contrast agents, and hence, improve patient outcomes.

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“…Further studies suggest similar survival advantage in patients who underwent complete resection vs. partial resection providing level 2b evidence of the benefit of surgery in high-grade glioma. A recent meta-analysis included an analysis of 12,607 patients from 34 studies and concluded that there is an improvement in survival times, functional recovery and tumour recurrence rate with increasing extents of safe resection [33]. However, there is an important but inherent bias in all studies that suggest Improved survival in primary and secondary malignant astrocytoma Nomiya et al [21] Retrospective, single centre 170 patients with anaplastic astrocytoma EOR was the most important prognostic factor on multivariate analysis Stummer et al [22] Phase III RCT, multi-centre 322 patients with suspected malignant glioma 5-ALA enables a more complete resection which leads to improved progression-free survival Keles et al [23] Retrospective, single centre 102 adult patients with hemispheric anaplastic astrocytoma Volume of residual disease was the most important prognostic indicator on time to tumour progression Pope et al [24] Retrospective, single centre 110 patients with glioblastoma, 41 patients with anaplastic astrocytoma EOR was not a statistically meaningful predictor of survival Ushio et al [25] Retrospective, single centre 105 consecutive patients with hemispheric glioblastoma Progression-free survival and overall survival was significantly better in the gross total resection group compared to the partial resection group and biopsy group Puduvalli et al [26] Retrospective, multi-centre 106 patients with anaplastic oligodendroglioma 'A trend towards longer survival with a greater extent of resection' a survival advantage; patients who undergo total resection are usually younger, with a good performance status and have a glioma in a non-eloquent location.…”

Section: The Value Of Extent Of Resectionmentioning

confidence: 99%

Novel Surgical Approaches to High-Grade Gliomas

Rasul

Watts

2015

Curr Treat Options Neurol

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Treatment of patients with high-grade glioma (HGG) should begin with thorough evaluation by a specialized multidisciplinary team to determine whether or not the patient is appropriate for surgery, chemotherapy and radiotherapy. Particular attention should be paid to the performance status and neurological function. Surgery is the first step in therapeutic intervention. Patients undergo either biopsy, debulking surgery or maximal resection depending on the anatomical location of the tumour and the patient's clinical condition. Extent of resection has a prognostic value. In patients who are 'fit for surgery', the aim is to remove all contrast-enhancing tumour without causing neurological deficit. If microsurgical resection is not feasible, then a biopsy, either open or stereotactic, should be performed to confirm high-grade glioma diagnosis and to perform molecular genetic analyses (MGMT methylation status, loss of heterozygosity in 1p/19q, IDH1 status) as this has treatment implications. Over the past decade, much glioma research has focussed on novel surgical approaches to improve long-term outcomes. The evidence to support the benefit of maximizing extent of resection is growing. Advances in neurosurgical techniques allow safer, more aggressive surgery to maximize tumour resection whilst minimizing neurological deficit. Surgical adjuncts including advanced neuronavigation, intraoperative magnetic resonance imaging, high-frequency ultrasonography, fluorescence-guided microsurgery using intraoperative fluorescence, functional mapping of motor and language pathways, and locally delivered therapies are extending the armamentarium of the neurosurgeon to provide patients with the best outcome. Operating on elderly patients and those with recurrent disease, although controversial, is becoming more common due to emerging neurosurgical approaches. Here, we discuss the emerging surgical techniques and comment on the future of HGG surgery.

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Biopsy versus partial versus gross total resection in older patients with high-grade glioma: a systematic review and meta-analysis

Cited by 140 publications

References 80 publications

Current status and perspectives of interventional clinical trials for glioblastoma – analysis of ClinicalTrials.gov

Current status and perspectives of interventional clinical trials for glioblastoma – analysis of ClinicalTrials.gov

Terahertz reflectometry imaging for low and high grade gliomas

Novel Surgical Approaches to High-Grade Gliomas

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