Evidence-based recommendations on categories for extent of resection in diffuse glioma

Abstract

Surgical resection represents the standard of care in diffuse glioma, and more extensive tumour resection appears to be associated with favourable outcome. Up to now, terminology to describe extent of resection has been inconsistently applied across clinical trials which hampers comparative analysis of cohorts between different studies. Based on a comprehensive literature review, we developed evidence-based expert recommendations on categories for extent of resection. Recommendations are formulated for the categories 'biopsy', 'partial resection', 'subtotal resection', 'near total resection', 'complete resection' and 'supramaximal resection'. Definitions rest on reduction of contrast-and nonecontrast-enhancing tumour in glioblastoma, and on reduction of T2/FLAIR-hyperintense tumour in gliomas WHO grade 2 or 3. Both relative reduction of tumour volume (in percentage) as a measurement of surgical efficacy and absolute residual tumour volume (in cm 3 ) as a measurement of remaining tumour burden are incorporated into the categories for extent of resection. Class of evidence for the proposed categories ranges from class IIB to IV. Limitations of the suggested categories are discussed. The proposed categories on extent of resection offer a framework to standardize

Towards more accurate preclinical glioblastoma modelling: reverse translation of clinical standard of care in a glioblastoma mouse model

“…Treatments were started at day 14 after tumor cells inoculation, when a well-established tumor mass was present in accordance with the clinical situation at tumor diagnosis. It has been shown that the extent of resection (EOR) represents an independent prognostic factor for GBM, with patients undergoing gross total removal of the tumor surviving significantly longer than patients receiving partial resection [19,20]. In this study, we were able to model these two different situations and we confirmed their impact on survival.…”

Feasibility, Safety and Impact on Overall Survival of Awake Resection for Newly Diagnosed Supratentorial IDH-Wildtype Glioblastomas in Adults

“…This suggests that resecting the apparently normal tissue at the tumor periphery decreases the number of remaining infiltrating isolated glioma cells. In a recent literature review, the impact of supratotal resection on overall survival in glioblastoma patients was assessed at an evidence level of III [48]. Li et al previously reported the largest series of resected glioblastomas, showing that pushing the boundary to 100% resection and beyond, along with the removal of a significant amount of the FLAIR abnormality region, may result in longer survival without significant increases in postoperative morbidity [47].…”

The evolving role of neurosurgery for central nervous system metastases in the era of personalized cancer therapy

“…Fluorescence-guided resection in brain metastases has been described [57]; however, the use of 5-aminolevulinic acid (ALA) does not seem to translate into improved local control or survival in patients with brain metastases [58]. This might be due to inconsistent fluorescence of brain metastases (ranging from 25 to 83% depending on the type of primary tumour, with less common fluorescence in melanoma metastases and more common fluorescence in ductal breast cancer metastases) [58e60], a less strict correlation of extent of resection and outcome compared to primary brain tumours [55,61], and the use of stereotactic radiosurgery as an effective salvage therapy [39]. Importantly, the presence of 5-ALA fluorescence per se has been shown to be associated with more favorable survival and lower local relapse rates, which potentially points towards a role of 5-ALA as a marker tumour infiltration and angiogenesis [59].…”