Partial resection offers an overall survival benefit over biopsy in MGMT-unmethylated IDH-wildtype glioblastoma patients

Hallaert, Giorgio; Pinson, Harry; Vanhauwaert, Dimitri; Broecke, Caroline Van den; Roost, Dirk Van; Boterberg, Tom; Kalala, Jean-Pierre

doi:10.1016/j.suronc.2020.10.016

Cited by 4 publications

(2 citation statements)

References 26 publications

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“…Generally, the median OS of the entire cohort of this study is comparable to other studies investigating patients with GBM [ 39 , 40 ]. However, other studies show a longer median OS [ 4 , 41 , 42 ]. This difference is likely due to a higher number of included elderly patients in our study.…”

Section: Discussionmentioning

confidence: 96%

Influence of MMR, MGMT Promotor Methylation and Protein Expression on Overall and Progression-Free Survival in Primary Glioblastoma Patients Treated with Temozolomide

Brawanski

Sprung

Freyschlag

et al. 2023

IJMS

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Glioblastoma is the most common malignant brain tumor in adults. Standard treatment includes tumor resection, radio-chemotherapy and adjuvant chemotherapy with temozolomide (TMZ). TMZ methylates DNA, whereas O6-methylguanine DNA methyltransferase (MGMT) counteracts TMZ effects by removing the intended proteasomal degradation signal. Non-functional MGMT mediates the mismatch repair (MMR) system, leading to apoptosis after futile repair attempts. This study investigated the associations between MGMT promoter methylation, MGMT and MMR protein expression, and their effect on overall survival (OS) and progression-free survival (PFS) in patients with glioblastoma. MGMT promoter methylation was assessed in 42 treatment-naïve patients with glioblastoma WHO grade IV by pyrosequencing. MGMT and MMR protein expression was analyzed using immunohistochemistry. MGMT promoter methylation was present in 52%, whereas patients <70 years of age revealed a significantly longer OS using a log-rank test and a significance threshold of p ≤ 0.05. MGMT protein expression and methylation status showed no correlation. MMR protein expression was present in all patients independent of MGMT status and did not influence OS and PFS. Overall, MGMT promoter methylation implicates an improved OS in patients with glioblastoma aged <70 years. In the elderly, the extent of surgery has an impact on OS rather than the MGMT promoter methylation or protein expression.

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Section: Discussionmentioning

confidence: 96%

Influence of MMR, MGMT Promotor Methylation and Protein Expression on Overall and Progression-Free Survival in Primary Glioblastoma Patients Treated with Temozolomide

Brawanski

Sprung

Freyschlag

et al. 2023

IJMS

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“…Although a benefit of GTR in GBM patients has been confirmed by many studies [34][35][36][37], data on the impact of EOR on outcome in elderly (≥ 65), often fragile patients are scarce and less specific, but favor resection over biopsy only protocols [4,8,10,12,38,39]. A survival benefit for any microsurgical glioma surgery compared to biopsy only in IDH-wildtype GBM patients -regardless of the extent of resection -has been reported [39,40] as well as a survival benefit for GTR compared to partial/subtotal resection and biopsy only in a recent study with a large cohort of GBM patients older than 65 years [8]. Since GBM patients who only underwent biopsy were excluded from our study, we cannot draw a reasonable conclusion in favor of glioma resection in elderly GBM patients.…”

Section: Discussionmentioning

confidence: 96%

Surgeon experience in glioblastoma surgery of the elderly—a multicenter, retrospective cohort study

Pöppe

Machegger²,

Steinbacher³

et al. 2023

J Neurooncol

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Purpose To assess the impact of individual surgeon experience on overall survival (OS), extent of resection (EOR) and surgery-related morbidity in elderly patients with glioblastoma (GBM), we performed a retrospective case-by-case analysis. Methods GBM patients aged ≥ 65 years who underwent tumor resection at two academic centers were analyzed. The experience of each neurosurgeon was quantified in three ways: (1) total number of previously performed glioma surgeries (lifetime experience); (2) number of surgeries performed in the previous five years (medium-term experience) and (3) in the last two years (short-term experience). Surgeon experience data was correlated with survival (OS) and surrogate parameters for surgical quality (EOR, morbidity). Results 198 GBM patients (median age 73.0 years, median preoperative KPS 80, IDH-wildtype status 96.5%) were included. Median OS was 10.0 months (95% CI 8.0–12.0); median EOR was 89.4%. Surgery-related morbidity affected 19.7% patients. No correlations of lifetime surgeon experience with OS (P = .693), EOR (P = .693), and surgery-related morbidity (P = .435) were identified. Adjuvant therapy was associated with improved OS (P < .001); patients with surgery-related morbidity were less likely to receive adjuvant treatment (P = .002). In multivariable testing, adjuvant therapy (P < .001; HR = 0.064, 95%CI 0.028–0.144) remained the only significant predictor for improved OS. Conclusion Less experienced neurosurgeons achieve similar surgical results and outcome in elderly GBM patients within the setting of academic teaching hospitals. Adjuvant treatment and avoidance of surgery-related morbidity are crucial for generating a treatment benefit for this cohort.

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Effect of Extent of Resection on Survival of Patients with Glioblastoma, IDH–Wild-Type, WHO Grade 4 (WHO 2021): Systematic Review and Meta-Analysis

et al. 2023

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Partial resection offers an overall survival benefit over biopsy in MGMT-unmethylated IDH-wildtype glioblastoma patients

Cited by 4 publications

References 26 publications

Influence of MMR, MGMT Promotor Methylation and Protein Expression on Overall and Progression-Free Survival in Primary Glioblastoma Patients Treated with Temozolomide

Influence of MMR, MGMT Promotor Methylation and Protein Expression on Overall and Progression-Free Survival in Primary Glioblastoma Patients Treated with Temozolomide

Surgeon experience in glioblastoma surgery of the elderly—a multicenter, retrospective cohort study

Effect of Extent of Resection on Survival of Patients with Glioblastoma, IDH–Wild-Type, WHO Grade 4 (WHO 2021): Systematic Review and Meta-Analysis

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