Perilesional Resection of Glioblastoma Is Independently Associated With Improved Outcomes

Abstract

BACKGROUND Resection is a critical component in the initial treatment of glioblastoma (GBM). Often GBMs are resected using an intralesional method. Circumferential perilesional resection of GBMs has been described, but with limited data. OBJECTIVE To conduct an observational retrospective analysis to test whether perilesional resection produced a greater extent of resection. METHODS We identified all patients with newly diagnosed GBM who underwent resection at our institution from June 1, 1993 to December 31, 2015. Demographics, presenting symptoms, intraoperative data, method of resection (perilesional or intralesional), volumetric imaging data, and postoperative outcomes were obtained. Complete resection (CR) was defined as 100% resection of all contrast-enhancing disease. Univariate analyses employed analysis of variance (ANOVA) and Fisher's exact test. Multivariate analyses used propensity score-weighted multivariate logistic regression. RESULTS Newly diagnosed GBMs were resected in 1204 patients, 436 tumors (36%) perilesionally and 766 (64%) intralesionally. Radiographic CR was achieved in 69% of cases. Multivariate analysis demonstrated that perilesional tumor resection was associated with a significantly higher rate of CR than intralesional resection (81% vs 62%, multivariate odds ratio = 2.5, 95% confidence interval: 1.8-3.4, P < .001). Among tumors in eloquent cortex, multivariate analysis showed that patients who underwent perilesional resection had a higher rate of CR (79% vs 58%, respectively, P < .001) and a lower rate of neurological complications (11% vs 20%, respectively, P = .018) than those who underwent intralesional resection. CONCLUSION Circumferential perilesional resection of GBM is associated with significantly higher rates of CR and lower rates of neurological complications than intralesional resection, even for tumors arising in eloquent locations. Perilesional resection, when feasible, should be considered as a preferred option.

Importance and Evidence of Extent of Resection in Glioblastoma

“…This was also the case for tumors arising in eloquent loca-tions. 62 A retrospective review of the survival benefit of additional lobectomy after GTR versus GTR alone in IDHwt GB located in either the nondominant frontal or temporal lobe was recently performed. 63 Of 40 patients evenly divided into each arm, the median PFS for GTR was 11.5 months and 30.7 months for lobectomy (p ¼ 0.007) and the OS for GTR was 18.7 months versus 44.1 months for lobectomy 44.1 (p ¼ 0.04).…”

Evidence-based recommendations on categories for extent of resection in diffuse glioma

“…Al-Holou et al, 2020[39] Definitions of 'gross total resection', numbers of patients in which 'gross total resection' was achieved, and patient inclusion criteria are given. Abbreviations: KPS, Karnofsky performance score; WHO, World Health Organization.…”

A Time-Tested Information System in Neurosurgical Oncology

“…In what is probably the largest single-center series of glioblastoma patients with extensive tumor resections, their study supported the established association between extent of resection and survival and moreover, showed that going beyond a conventional 100% resection (of all contrast-enhancing tumor) by also removing a significant portion of the fluid-attenuated inversion recovery (FLAIR) abnormality region, when safely feasible, may prolong survival without significantly increasing overall or neurological postoperative morbidity. More recently, Al-Holou et al (5) drew data from our database on 1204 patients with glioblastoma to show that relative to piecemeal resection of these tumors, circumferential perilesional resection is significantly and independently associated with improved outcomes. Clearly, studies such as these on a scale this large would have been impossible without a patient database as robust and extensive as ours, and one that ensured that data typically inconsistently recorded in the medical records, such as method of tumor removal, or data not typically available, such as volumetric perioperative analyses of all brain tumors is regularly and consistently documented.…”