Indications for Surgery in the Management of Gliomas

Cohadon, F

doi:10.1007/978-3-7091-6925-4_6

Cited by 31 publications

(14 citation statements)

References 155 publications

(82 reference statements)

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“…12 There is increasing evidence in the literature to suggest that extensive resection is associated with improved survival. [3][4][5][6][7][8] Lacroix et al has demonstrated that to achieve a survival benefit, radical resection of greater than 97% of enhancing tumour is necessary, although there is a trend for survival benefit once tumour resection exceeds 89%. 8 Although none of these data constitute Class I evidence, it does show an increasing trend that aggressive tumour resection can be performed with low morbidity with better survival outcome compared to more conservative surgery.…”

Section: Discussionmentioning

confidence: 99%

“…However, the role of aggressive resection in improving overall survival remains contentious, although there is evolving data to suggest this trend. [3][4][5][6][7][8][9] Definitive evidence will necessitate a well-designed randomized prospective trial, although it is not likely that this will be possible or feasible. 10 One possible advantage of aggressive tumour resection is a rapid reduction in oncological burden which may augment adjuvant chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Higher glioblastoma tumour burden reduces efficacy of chemotherapeutic agents: in vitro evidence

Wan

Too

2007

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Higher glioblastoma tumour burden reduces efficacy of chemotherapeutic agents: in vitro evidence

Wan

Too

2007

Journal of Clinical Neuroscience

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“…T his has led to an increasing interest in the economics of various disciplines in m edicine and surgery including neurosurgery. 3,7,8,14,15 A retrospective analysis of the costs of 1 year' s adm issions to the W essex N eurosurgical centre in England was analysed. 7 T his reported the observed and predicted outcom es with and without neurosurgery.…”

Section: Discussionmentioning

confidence: 99%

“…1± 3 These survival tim es represent optim al treatm ent outcom es and do not re¯ect overall population survival, since m any patients with the radiological diagnosis of m alignant gliom a do not, for a variety of reasons, undergo any interventional treatment. 3,4 In such patients the m edian survival tim es are of the order 8± 14 w eeks. 3,5,6 Since the prognosis for patients with m alignant gliom a is poor the question of costs of treatm ents and their cost-effectiveness are becom ing particularly pertinent at a tim e when there are increasing demands for the ef® cient use of lim ited health care resources.…”

Section: Introductionmentioning

confidence: 99%

The costs of managing patients with malignant glioma at a neuro-oncology clinic*

Latif¹,

Signorini²,

Gregor³

et al. 1998

British Journal of Neurosurgery

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Malignant glioma (glioblastoma and anaplastic astrocytoma) remain incurable despite extensive resection, radiotherapy, chemotherapy and experimental therapies. Few studies have addressed either the costs of various treatments for malignant glioma or their cost effectiveness. The aims of this study were to identify direct hospital costs of treating patients with biopsy proven malignant glioma. The study was carried out within the setting of a dedicated neuro-oncology clinic at a university teaching hospital and included 236 patients treated between 1989 and 1995. The study used the unit costing of each item of treatment according to NHS National Costing Project. The cost of treatment was broken down into its various components: bed days, investigations, surgery, radiotherapy, chemotherapy and neuro-oncology out-patient follow-ups. The mean costs for each of the items based on 1995 figures for the 157 patients having surgery followed by radiotherapy were neuroradiological investigations (442 Pounds), neurosurgical bed days (2407 Pounds), neurosurgery (2068 Pounds), neuropathology (434 Pounds), radiotherapy (8832 Pounds), out-patients (1078 Pounds) and chemotherapy (440 Pounds). Total treatment costs per patient ranged from 1978 Pounds to 26,980 Pounds. Median costs of care decreased sequentially with worsening MRC Brain Tumour prognostic group. Management of patients with the best prognosis (MRC index score of 1-10) cost a median of 16,550 Pounds (range 4572-26,090 Pounds) whilst the median management cost of those in the worst prognostic group (MRC score 34-38) was 6514 Pounds (range 1978-18,360 Pounds). The median cost of each week of survival in the patients with the best outcome (MRC score 1-10) was < 150 Pounds compared to 232 Pounds for each week of survival for patients in the worst prognostic group (MRC score 34-38). This study made no attempt to collect costs of supportive or community-based care. Prospective studies are required to collect such data, as well as assessing the costs effectiveness of alternative treatment strategies.

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“…2,9,10,30 The resection of an enhancing tumor (grosstotal resection) is known to prolong progression-free and overall survival time of patients. 32,35,36 Most tumor progressions are detected within the 1st year after surgery; thus, accurate postoperative assessment is important.…”

confidence: 99%

Time window for postoperative reactive enhancement after resection of brain tumors: less than 72 hours

Lescher

Schniewindt

Jurcoane

et al. 2014

FOC

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Object Early postoperative MRI within 72 hours after brain tumor surgery is commonly used to assess residual contrast-enhancing tumor. The 72-hour window is commonly accepted because previous 1.5-T MRI studies have not found confounding postoperative reactive contrast enhancement in this time frame. The sensitivity to detect contrast enhancement increases with the field strengths. Therefore, the authors aimed to assess whether the 72-hour window is also appropriate for the MRI scanner with a field strength of 3 T. Methods The authors retrospectively analyzed findings on early postsurgical MR images acquired in 46 patients treated for high-grade gliomas. They performed 3-T MRI within 7 days before surgery and within 72 hours thereafter. The appearance of enhancement was categorized as postoperative reactive enhancement or tumoral enhancement by comparison with the pattern and location of presurgical enhancing tumor. Results Postoperative reactive enhancement was present in 15 patients (32.6%). This enhancement, not seen on presurgical MRI, had a marginal or leptomeningeal/dural pattern. In 13 patients (28.3%) postsurgical enhancement was found within the first 72 postoperative hours, with the earliest seen 22:57 hours after surgery. Subsequent MR scans in patients with postoperative reactive enhancement did not reveal tumor recurrence in these regions. Conclusions Postoperative reactive enhancement earlier than 72 hours after brain tumor surgery can be expected in about one-third of the cases in which a 3-T scanner is used. This might be due to the higher enhancement-to-brain contrast at higher field strengths. Therefore, the time window of 72 hours does not prevent reactive enhancement, which, however, can be recognized as such comparing it with presurgical enhancing tumor.

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Indications for Surgery in the Management of Gliomas

Cited by 31 publications

References 155 publications

Higher glioblastoma tumour burden reduces efficacy of chemotherapeutic agents: in vitro evidence

Higher glioblastoma tumour burden reduces efficacy of chemotherapeutic agents: in vitro evidence

The costs of managing patients with malignant glioma at a neuro-oncology clinic*

Time window for postoperative reactive enhancement after resection of brain tumors: less than 72 hours

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