High Grade Glioma Surgery - Clinical Aspects and Prognosis

Abstract

Introduction: High grade gliomas (HGG) are a group of tumors with infiltrative nature in general. Surgery is the first step in their treatment. It can be beneficial in two aspects: firstly, in establishing normal intracranial pressure and, secondly, in reducing the tumour volume. The choice of method depends on the location of the lesion, the expected grade of malignancy, and the general condition of the patient. Despite constant development of neuro-oncology and microsurgical techniques, the 5-year survival rate in patients with HGG remains less than 10% and the median survival is still less than 2 years.  Aim: At present, there is no final therapeutic “segment” to provide a better outcome than the complex treatment of HGG. Moreover, the treatment’s relative efficacy and recurrence of these tumours carry an additional problem. The aim of this study was to estimate the overall survival of patients with HGG operated in our clinic and compare it with literature data.  Materials and methods: One hundred twenty-one cranial operations for HGG were reviewed (conducted between 2014 and 2019). Summary characteristics of the various parameters were presented in respect to the radical nature of the operative intervention using Kaplan-Meier analysis and chi square tests. All patients were followed up at regular check-ups. Results: HGGs were 103 or 85.12% of all gliomas operated for the 2014-2019 period. The most common cases were in the 51 to 60 age group. The cases in men were twice as common. The most common localization of the neoplasm is in the temporal region (36.36%) and the rarest was found in the occipital region (3.30%). It was estimated that our operated patients with HGG had 12.23 months over-all survival. Gross total resected patients had a median survival (OS) of 14.53 months, while subtotal resected patients had a median survival (OS) of 10.44 months. It is estimated 7.97 months free tumor survival period (time to relapse - FTS) for our operated patients with HGG. Gross total resected patients had a median FTS of 10.88 months, while subtotal resected patients had median FTS of 5.70 months. We noticed permanent new neurological deficit (NND) in 20 patients (19.45%) operated with GTR, and in 5 patients (4.85%) operated with STR.  Conclusions: Median survival - OS, free tumor survival period - FTS and new neurological deficit - NND were statistically significant (p<0.05) with extent of resection – GTR or STR in our study. Maximal safe radical (total) or supratotal resection is preferred in treating HGG. 

Clinical management and survival outcomes of patients with different molecular subtypes of diffuse gliomas in China (2011–2017): a multicenter retrospective study from CGGA

“…In our study, subtotal resection, compared with total resection, was not a significant factor in the outcomes of patients with IDH-mutant molecular subtypes, thereby indicating that the extent of resection exerts different effects on the prognosis of patients with different molecular subtypes 23,45 . Different resection strategies should be considered for patients with different molecular subtypes.…”

Risk factors, prognostic potency, and longitudinal variation of anxiety and depression in postoperative glioma patients

“…At present, the main treatment for glioma is surgical resection, and other treatments include radiation therapy, chemotherapy, and emerging immunotherapy (3)(4)(5). Even with these treatments, the prognosis of glioma patients is still unfavorable (6,7). According to previous studies, the median survival time for patients with low-grade glioma (LGG) (World Health Organization (WHO) I-II grade) is 5.6-13.3 years, while for patients with high-grade glioma (HGG) (WHO III-IV grade), it is only 12.2-15.4 months (7)(8)(9)(10).…”

“…Even with these treatments, the prognosis of glioma patients is still unfavorable (6,7). According to previous studies, the median survival time for patients with low-grade glioma (LGG) (World Health Organization (WHO) I-II grade) is 5.6-13.3 years, while for patients with high-grade glioma (HGG) (WHO III-IV grade), it is only 12.2-15.4 months (7)(8)(9)(10). Poor survival of glioma patients may lead to a heavy mental burden (11,12).…”

Palliative care for patients with glioma: A recent scientometric analysis of the Web of Science in 2022

“…The recurrence rate is high, the reported 5-year survival rate of patients with GBM remains less than 10%, and the median survival is still less than 2 years. Patients who underwent gross total resection had a median overall survival (OS) of 14.53 months, while patients who underwent subtotal resection had a median survival (OS) of 10.44 months ( 11 ). General and disease-specific symptoms are common in the disease trajectory, especially in the end-of-life phase.…”