Impact of extent of resection of newly diagnosed glioblastomas on survival: a meta-analysis

Abstract

Background Because of the continuing practice variation regarding the extent of glioblastoma (GBM) resection, we sought to systematically examine the recent literature to evaluate the impact of the extent of resection of primary GBM on patients’ survival. Main body of the abstract We examined all the published studies from January 2009 to January 2020 concerning primary glioblastoma resection and survival. The data synthesis was performed using the random-effects model in Review Manager (version 5.3; Cochrane Collaboration). Eight studies met our selection criteria. The included studies involved a total of 2249 patients. A total of 1247 patients underwent gross total resection (GTR) of the GBM, and 1002 experienced an incomplete resection. The mean progression-free survival for GTR versus incomplete resection was 10 versus 6.3 months, and the mean overall survival (GTR vs. incomplete resection) was 28.7 versus 13.5 months. Using the random-effects model, the outcome results revealed that GTR was insignificantly different than incomplete resection on survival among the included cases (P value: 0.47). The quality of evidence of the available studies was of low certainty. Conclusion The outcome results revealed that gross total resection was insignificantly different than incomplete resection on survival among the included cases (P value: 0.47). However, the quality of evidence of the available studies was of low certainty. Additionally, no data on patients’ quality of life were reported across the included studies. Thus, prospective randomized controlled trials are required to investigate both the safety and the survival benefit of GTR of glioblastoma.

Genetic Prognostic Factors in Adult Diffuse Gliomas: A 10-Year Experience at a Single Institution

“…We observed an apparent difference (although not statistically significant) in the OS of gross (GTR) versus near-total resection (NTR) glioma patients, which is consistent with findings by Abdelfath et al [ 75 ]. GTR appears to be more beneficial than subtotal resection (STR) in extending the life of elderly individuals with high-grade glioma [ 76 ].…”

Overview of prognostic factors in adult glioma; a 10-year experience at a single institution

“…We observed an apparent difference (although not statistically significant) in the OS of gross (GTR) versus near total resection (NTR) glioma patients, which is consistent with findings by Abdelfath et al 31 . GTR appears to be more beneficial than subtotal resection (STR) in extending the life of elderly individuals with high-grade glioma 32 prognosis.…”

Glioblastoma Therapy: Past, Present and Future

“…This SOC includes maximal safe resection, radiotherapy with concurrent (75 mg/m 2 /day × 6 weeks) and adjuvant TMZ (150–200 mg/m 2 /day × 5 days for six 28-day cycles). Since then, similar results (mOS 15–18 months) have been observed in other clinical studies [ 250 , 251 , 252 ]. Despite significant advances in the understanding of the molecular biology and pathophysiology of the GB, SOC has remained unchanged, excepting the possibility of adding or not tumor treating fields (TTFields) [ 13 , 253 , 254 ].…”

“…Despite significant advances in the understanding of the molecular biology and pathophysiology of the GB, SOC has remained unchanged, excepting the possibility of adding or not tumor treating fields (TTFields) [13,253,254]. GB mostly recurs within 2-3 cm from the borders of the initial lesion and with multiple lesions, thus, maximal surgical resection improves survival irrespective of the age of the patient or the molecular status of the tumor [252,268]. Preoperative brain mapping techniques such as navigated transcranial magnetic stimulation (nTMS), magnetoencephalography, functional MRI, and diffusion tract imaging (DTI) are used to facilitate safe resections and minimize surgical complications [269].…”