Maximizing the extent of resection and survival benefit of patients in glioblastoma surgery: High-field iMRI versus conventional and 5-ALA-assisted surgery

Röder, Constantin; Bisdas, Sotirios; Ebner, Florian; Honegger, Jürgen; Nägele, Thomas; Ernemann, Ulrike; Tatagiba, Marcos

doi:10.1016/j.ejso.2013.11.022

Cited by 123 publications

(90 citation statements)

References 21 publications

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“…5,11,14 The use of iMRI in pediatric neurosurgery has been described and evaluated in a few retrospective studies with low-4,9,12,13 and high-field 2,3,6,7,15,16 magnets for various pathologies including glioma, vascular, and epilepsy surgery. A common conclusion in these studies is that iMRI is a safe technology for increasing the extent of resection (EOR) in pediatric patients.…”

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confidence: 99%

Beneficial impact of high-field intraoperative magnetic resonance imaging on the efficacy of pediatric low-grade glioma surgery

Röder¹,

Breitkopf²,

MS³

et al. 2016

FOC

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OBJECTIVE Intraoperative MRI (iMRI) is assumed to safely improve the extent of resection (EOR) in patients with gliomas. This study focuses on advantages of this imaging technology in elective low-grade glioma (LGG) surgery in pediatric patients. METHODS The surgical results of conventional and 1.5-T iMRI-guided elective LGG surgery in pediatric patients were retrospectively compared. Tumor volumes, general clinical data, EOR according to reference radiology assessment, and progression-free survival (PFS) were analyzed. RESULTS Sixty-five patients were included in the study, of whom 34 had undergone conventional surgery before the iMRI unit opened (pre-iMRI period) and 31 had undergone surgery with iMRI guidance (iMRI period). Perioperative data were comparable between the 2 cohorts, apart from larger preoperative tumor volumes in the pre-iMRI period, a difference without statistical significance, and (as expected) significantly longer surgeries in the iMRI group. According to 3-month postoperative MRI studies, an intended complete resection (CR) was achieved in 41% (12 of 29) of the patients in the pre-iMRI period and in 71% (17 of 24) of those in the iMRI period (p = 0.05). Of those cases in which the surgeon was postoperatively convinced that he had successfully achieved CR, this proved to be true in only 50% of cases in the pre-iMRI period but in 81% of cases in the iMRI period (p = 0.055). Residual tumor volumes on 3-month postoperative MRI were significantly smaller in the iMRI cohort (p < 0.03). By continuing the resection of residual tumor after the intraoperative scan (when the surgeon assumed that he had achieved CR), the rate of CR was increased from 30% at the time of the scan to 85% at the 3-month postoperative MRI. The mean follow-up for the entire study cohort was 36.9 months (3–79 months). Progression-free survival after surgery was noticeably better for the entire iMRI cohort and in iMRI patients with postoperatively assumed CR, but did not quite reach statistical significance. Moreover, PFS was highly significantly better in patients with CRs than in those with incomplete resections (p < 0.001). CONCLUSIONS Significantly better surgical results (CR) and PFS were achieved after using iMRI in patients in whom total resections were intended. Therefore, the use of high-field iMRI is strongly recommended for electively planned LGG resections in pediatric patients.

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confidence: 99%

Beneficial impact of high-field intraoperative magnetic resonance imaging on the efficacy of pediatric low-grade glioma surgery

Röder¹,

Breitkopf²,

MS³

et al. 2016

FOC

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“…61 On the other hand, there is sparse evidence that intraoperative MRI is superior to fluorescence with regard to residual tumour volumes, completeness of resection and neurological outcomes. 62 In fact, ALA fluorescence technology revealed that GBM is more widespread infiltrating than the contrast-enhanced MRI had demonstrated, enabling intraoperative margin adaptation. 63 The intraoperative fluorescence signal corresponds well with the histopathological tumour infiltration in ALA-positive resection planes.…”

Section: Imaging Implications In Neurosurgerymentioning

confidence: 99%

Glioblastoma multiforme: emerging treatments and stratification markers beyond new drugs

Neubeck¹,

Seidlitz²,

Kitzler³

et al. 2015

BJR

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Glioblastoma multiforme (GBM) is the most common primary brain tumour in adults. The standard therapy for GBM is maximal surgical resection followed by radiotherapy with concurrent and adjuvant temozolomide (TMZ). In spite of the extensive treatment, the disease is associated with poor clinical outcome. Further intensification of the standard treatment is limited by the infiltrating growth of the GBM in normal brain areas, the expected neurological toxicities with radiation doses .60 Gy and the dose-limiting toxicities induced by systemic therapy. To improve the outcome of patients with GBM, alternative treatment modalities which add low or no additional toxicities to the standard treatment are needed. Many Phase II trials on new chemotherapeutics or targeted drugs have indicated potential efficacy but failed to improve the overall or progression-free survival in Phase III clinical trials. In this review, we will discuss contemporary issues related to recent technical developments and new metabolic strategies for patients with GBM including MR (spectroscopy) imaging, (amino acid) positron emission tomography (PET), amino acid PET, surgery, radiogenomics, particle therapy, radioimmunotherapy and diets.

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“…[40,41] In addition, the time for image acquiring and the need of stop the surgery for it, prolong time of surgery and anesthesia. [42][43][44] Roder et al studied retrospectively 117 patients after conventional surgery, after 5-ALA, and after iMRI they found that mean residual tumor volume after iMRI-assisted surgery (0.5 [0.0e4.7] cm 3 ) was significantly smaller compared to the residual tumor volume after 5-ALAguided surgery (1.9 [0.0-13.2] cm 3 ; P = 0.022), which was significantly smaller than in conventional surgery (4.7 [0.0-30.6] cm 3 ; P = 0.007). Total resections were significantly more common in iMRI (74%) than in 5-ALAassisted (46%, P = 0.05) or conventional surgery (13%, P = 0.03).…”

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confidence: 99%

“…[2] Despite it is a retrospective study with a short period of time and limited patients in different chronologic times, the great outcomes and promising results should open for new prospective studies. [42] Further, the quality of iMRI images remains an issue; pre-operative MRI images are usually acquired by high-fields MRI with DTI and fMRI as a surgery plan, though intra-operative images are usually low-field MRI with worse definitions without DTI and fMRI; thereby the surgery plan for critical and eloquent areas is difficult and questionable after tumor resection and brain shift. Also, studies related to contrast dosage/ timing and the local of resection have been done.…”

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confidence: 99%

Brain tumor surgery: supplemental intra-operative imaging techniques and future challenges

Belsuzarri¹,

Sangenis²,

Araújo³

2015

J Cancer Metastasis Treat

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Modern brain tumor surgery stands in the pillar of maximum safe resection. Tumor borders are always challenging, especially infiltration zones in malignant brain tumors. Novel technologies are designed for a better delineation and to increase the extent of resection (EOR) in brain tumor surgery, such as: cortical and sub-cortical mapping strategies with somatosensory-evoked potentials, awake stimulation mapping and cortical/sub-cortical stimulation for motor pathways, important for resection in eloquent areas; intra-operative imaging as functional and intra-operative magnetic resonance imaging, diffusion tensor imaging and intraoperative ultrasound are important for the tumor borders and to achieve the gross total resection; neurochemical navigation methods as 5-aminolevulinic and sodium fluorescein are important for the non-contrast-enhanced tumor border; future methods can be achieved with augmented reality surgery, new intra-operative chemical markers, and visualization methods. Nevertheless all these techniques seem to be promising, the real challenge in the future will be held in how to apply them and how they really affect the prognosis of the patients. Also, new concepts in tumor genetics will provide knowledge for the tumor behavior and will guide resection. Despite all limitations, the increasing importance of safe EOR shows the possible benefits of the novel technologies and surgical advances in brain tumor surgery, taking it to a new step of the neuronavigation era.

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Maximizing the extent of resection and survival benefit of patients in glioblastoma surgery: High-field iMRI versus conventional and 5-ALA-assisted surgery

Cited by 123 publications

References 21 publications

Beneficial impact of high-field intraoperative magnetic resonance imaging on the efficacy of pediatric low-grade glioma surgery

Beneficial impact of high-field intraoperative magnetic resonance imaging on the efficacy of pediatric low-grade glioma surgery

Glioblastoma multiforme: emerging treatments and stratification markers beyond new drugs

Brain tumor surgery: supplemental intra-operative imaging techniques and future challenges

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