Biopsy versus resection in the management of malignant gliomas: a systematic review and meta-analysis

Tsitlakidis, Abraham; Foroglou, Nicolas; Venetis, Christos A.; Patsalas, Ioannis; Hatzisotiriou, Athanasios; Selviaridis, Panagiotis

doi:10.3171/2009.7.jns09758

Cited by 38 publications

(11 citation statements)

References 90 publications

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“…37 Contrasting these 2 groups of patients is certainly clinically pertinent, but it is debatable whether a formal meta-analysis can or should be done. Other examples included evaluating the survival of patients with glioblastoma who underwent a biopsy only versus a resection, 106 the timing of surgery for patient with aneurysmal subarachnoid hemorrhage, 25 and comparing the risk of cranial neuropathy in patients who underwent radiosurgery compared with surgery for cavernous sinus meningiomas. 101 In other papers, there was no comparison group at all.…”

Section: Is a Meta-analysis Appropriate?mentioning

confidence: 99%

Methodology and reporting of meta-analyses in the neurosurgical literature

Klimo

Thompson

Ragel

et al. 2014

JNS

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Object. Neurosurgeons are inundated with vast amounts of new clinical research on a daily basis, making it difficult and time-consuming to keep up with the latest literature. Meta-analysis is an extension of a systematic review that employs statistical techniques to pool the data from the literature in order to calculate a cumulative effect size. This is done to answer a clearly defined a priori question. Despite their increasing popularity in the neurosurgery literature, meta-analyses have not been scrutinized in terms of reporting and methodology.Methods. The authors performed a literature search using PubMed/MEDLINE to locate all meta-analyses that have been published in the JNS Publishing Group journals (Journal of Neurosurgery, Journal of Neurosurgery: Pediatrics, Journal of Neurosurgery: Spine, and Neurosurgical Focus) or Neurosurgery. Accepted checklists for reporting (PRISMA) and methodology (AMSTAR) were applied to each meta-analysis, and the number of items within each checklist that were satisfactorily fulfilled was recorded. The authors sought to answer 4 specific questions: Are meta-analyses improving 1) with time; 2) when the study met their definition of a meta-analysis; 3) when clinicians collaborated with a potential expert in meta-analysis; and 4) when the meta-analysis was the only focus of the paper?Results. Seventy-two meta-analyses were published in the JNS Publishing Group journals and Neurosurgery between 1990 and 2012. The number of published meta-analyses has increased dramatically in the last several years. The most common topics were vascular, and most were based on observational studies. Only 11 papers were prepared using an established checklist. The average AMSTAR and PRISMA scores (proportion of items satisfactorily fulfilled divided by the total number of eligible items in the respective instrument) were 31% and 55%, respectively. Major deficiencies were identified, including the lack of a comprehensive search strategy, study selection and data extraction, assessment of heterogeneity, publication bias, and study quality. Almost one-third of the papers did not meet our basic definition of a meta-analysis. The quality of reporting and methodology was better 1) when the study met our definition of a meta-analysis; 2) when one or more of the authors had experience or expertise in conducting a meta-analysis; 3) when the meta-analysis was not conducted alongside an evaluation of the authors' own data; and 4) in more recent studies.Conclusions. Reporting and methodology of meta-analyses in the neurosurgery literature is excessively variable and overall poor. As these papers are being published with increasing frequency, neurosurgical journals need to adopt a clear definition of a meta-analysis and insist that they be created using checklists for both reporting and methodology. Standardization will ensure high-quality publications.

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Section: Is a Meta-analysis Appropriate?mentioning

confidence: 99%

Methodology and reporting of meta-analyses in the neurosurgical literature

Klimo

Thompson

Ragel

et al. 2014

JNS

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“…Surgically, the implementation of neuronavigation and the introduction of intraoperative 5-aminolevulinic acid (5-ALA) flourescent microsurgery have enhanced the possibilities to achieve a radiological gross total tumor resection [5]. A higher extent of tumor resection is associated with improved survival [3,[6][7][8]. Postoperative treatment with radiotherapy and temozolomide followed by adjuvant temozolomide has been introduced in clinical practice and is now standard of care for patients in good performance status [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Improved treatment of glioblastoma – changes in survival over two decades at a single regional Centre

et al. 2019

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Background: Glioblastoma (GBM) is an aggressive brain tumor with a short overall survival (OS) in general. The treatment of GBM has evolved over the last decades and is today multimodal including surgical resection followed by radiochemotherapy and adjuvant chemotherapy for patients in good performance status. The aim of this study was to evaluate the development of treatment and the outcome for GBM patients at a single regional center. Patients and methods: Survival was studied for 571 patients in our region diagnosed with GBM between 1995 and 2015. Samples from 244 patients out of those treated 2005-2015 have been included in a tissue/blood bank and a clinical database has been set up with basic patient characteristics and details on surgery and non-surgical treatment. Results: The median OS for all patients from 1995 to 2015 was 9.3 months. There was a stepwise improvement from 6.9 to 10.3 months for patients diagnosed 1995-1996 and 2010-2015, respectively (p < .05). The 2-year survival for the same time periods improved from 7% to 18% (p < .01). After introduction of postoperative radiochemotherapy for patients in good performance status in 2005 an increased OS was noted and following implementation of intraoperative 5-aminolevulinic acid the number of tumor resection !95% did increase from 33% to 54% (p < .001). Positive prognostic factors for survival were young age, good performance status, absence of inflammatory disease, absence of diabetes or metabolic disease, tumor resection !95%, and completion of postoperative radiochemotherapy. Discussion: The results of this study are consistent with earlier results regarding survival and prognostic factors and confirm results from randomized controlled trials in a clinical setting. Despite the improvements made, the prognosis is still dismal and the need for further research on GBM treatment is great.

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“…Survival rates further increased when EOR rates of 96-100% can be achieved. This is true not only for newly diagnosed GBM but also for recurrent GBM (3,4). In the latter, a cutoff of 80% EOR improved patients' outcome in the second line setting.…”

Section: Introductionmentioning

confidence: 90%

Complete radiological response following subtotal resection in three glioblastoma patients under treatment with Tumor Treating Fields

et al. 2019

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Glioblastoma multiforme (GBM) treatment consists of surgery, radiotherapy and chemotherapy with Temozolomide (TMZ). After subtotal resection (STR), residual tumors rarely undergo spontaneous regression. Overall survival (OS) and progression-free survival (PFS) are reduced when compared with gross total resection. There is evidence that adding Tumor Treating Fields (TTFields) to standard management may lead to a significant increase in PFS and OS. In 2015 and 2016, STR was performed in 27 patients with GBM. Of these, four subsequently received TTFields therapy in addition to chemotherapy. The present study presents a series of three patients with GBM (44-54 years; isocitrate dehydrogenase wild-type, methylated O6-methylguanine-DNA methyltransferase promoter) that were treated with radiochemotherapy and TTFields after STR. Therapy with TTFields started concomitantly to TMZ following radiotherapy and was maintained for 14, 24 and 37 months. TTFields were used as monotherapy in one case, as TMZ treatment had to be stopped due to toxicity for 1 month. In all patients, TTFields therapy was well tolerated at high compliance levels, resulting in complete response (CR) after 4, 5 and 7 months, respectively. Two patients remain tumor-free at 16 and 40 months after STR. One patient exhibited multifocal recurrence 11 months after the beginning of TTFields treatment but remains alive, presenting a mild neurological decline 24 months after starting TTFields. All three presented patients gave written informed consent for their data to be published. In conclusion, the current report detailed three patients with GBM who underwent STR and were subsequently treated with TMZ and TTFields. TTFields treatment was tolerated well and was applied accurately and with high compliance by these patients, which may have contributed to the complete response. Four of the 27 patients treated with STR received additional TTFields treatment. Three of these 4 showed a CR, while a CR was observed only 2 of the remaining 23 patients without TTFields. The current series supports the effects in clinical practice, as demonstrated in recent clinical trials. The results also demonstrated that adjuvant TTFields therapy can structurally affect residual tumors after STR.

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Biopsy versus resection in the management of malignant gliomas: a systematic review and meta-analysis

Abstract: Based on the best available evidence, it appears that cytoreductive resection in adults with supratentorial malignant glioma is associated with improved overall survival as compared with biopsy. However, well-designed prospective studies are needed for more solid conclusions to be drawn.

Cited by 38 publications

References 90 publications

Methodology and reporting of meta-analyses in the neurosurgical literature

Methodology and reporting of meta-analyses in the neurosurgical literature

Improved treatment of glioblastoma – changes in survival over two decades at a single regional Centre

Complete radiological response following subtotal resection in three glioblastoma patients under treatment with Tumor Treating Fields

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