Extending the resection beyond the contrast-enhancement for glioblastoma: feasibility, efficacy, and outcomes

Abstract

In this study, the volume of CE tumour remaining after resection is more important than FLAIR volume in regards to recurrence and survival for patients with GBM.

A Novel Comprehensive Clinical Stratification Model to Refine Prognosis of Glioblastoma Patients Undergoing Surgical Resection

“…Age, performance status, extent of surgical resection and MGMT methylation status are well known prognostic factors for GBM patients [4,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][39][40][41][42][43][44]. Nevertheless, the high degree of clinical/molecular heterogeneity found among GBM patients do not generally allow us to correctly classify GBM patients with the use of a single predictor or a few predictors.…”

“…There has been an increasing number of volumetric investigations highlighting the association between the EOR and survival [8,9,16,18,19,23,25,33]. Nowadays an increasing variety of neurosurgical methods are available (e.g., frameless navigational systems, intraoperative imaging, ultrasonography, and functional mapping) to achieve the optimum balance between a maximal resection and a safe resection.…”

“…There is still open discussion among neuroncologists regarding which tumoral component has to be considered (e.g., contrast enhancement, peritumoral edema, central necrosis [13,23,45].…”

“…To classify GBM cases according to this heterogeneity, different prognostic factors have been suggested for GBM, including age, performance status, specific molecular markers [e.g., MGMT methylation (O 6 -methylguanine-DNA methyl-transferase), mutation of IDH1, IDH2(isocitrate dehydrogenase) or TERT (telomerase reverse transcriptase), 1p19q codeletion, overexpression of EGFR (epidermal growth factor receptor)], the size of necrosis and the extent of resection (EOR) [15][16][17][18][19][20][21][22]. The role of EOR in improving survival in patients with GBM has widely been demonstrated, with more extensive resections providing added advantages [8,9,16,18,19,[23][24][25][26][27][28][29][30][31][32][33].…”

“…In this context, survival benefit based on extent of tumor resection has been reported to be as low as 78% and the greatest survival advantage has been seen in patients with EOR >95% [9]. Despite the infiltrative nature of this tumor, it still remains unclear if the resection beyond the contrast enhancement portion of the tumor translates into improved outcomes for patients with GBM [23].…”