Prognostic Implications of Extent of Resection in Glioblastoma: Analysis from a Large Database

Abstract

Hemangiopericytomas are rare central nervous system (CNS) tumors. We sought to investigate existing clinical management strategies and overall survival (OS) among patients with hemangiopericytomas arising from the CNS. Materials/Methods: All patients diagnosed with CNS hemangiopericytoma from 2004-2014 in the National Cancer Database were included. Clinical and treatment-related characteristics were recorded and analyzed for an association with OS following diagnosis using univariable and multivariable analyses. Results: Nine-hundred and eighty-one patients were included (0.22% of all CNS tumors). At diagnosis, 22 patients had spinal tumors (2%), 21 patients had multifocal tumors (2%) and 28 had disseminated disease (3%). Patients either underwent surgical resection and radiation (48%), surgery alone (37%), radiation alone (6%), or biopsy alone (9%). Of patients with known extent of resection, 53% underwent gross total resection, and, of patients with known radiation modality, 15% received stereotactic radiosurgery. Among the total cohort, 3 and 10 year OS was 87% and 59%, respectively. On multivariable analysis, factors associated with inferior OS included age (HRZ1.05, p<0.001), WHO grade (p<0.001), multifocal disease (HRZ2.59, pZ0.04), disseminated disease (HRZ2.67, pZ0.01), and chemotherapy (HRZ2.66, pZ0.01). Patients receiving surgery alone or surgery and radiation demonstrated improved OS compared to biopsy alone (HRZ0.45, pZ0.01 and HRZ0.47, pZ0.02, respectively). However radiation utilization did not impact OS (pZ0.691). Conclusion: The present data provide large-scale prognostic information from a contemporary cohort of patients with hemangiopericytoma and support an initial attempt at surgical extirpation. The benefits of ionizing radiation are likely limited to improved local control and neurologic function.

Association of Surgical Resection, Disability, and Survival in Patients with Glioblastoma

“…However, their data cannot differentiate between near-total resection and a lesser EOR, with a possible survival benefit of near-total resections. 26 In contrast, Sanai et al showed that subtotal tumor resection can impact OS in patients with a newly diagnosed GBM. 9 This is in line with the recent systematic review and meta-analysis of Brown et al that provides the evidence that resection < 95% improved OS compared with biopsy alone.…”

High‐grade Glioma – A decade of care in Christchurch

“…The literature has explored a number of aspects of the treatment of HGG. In terms of surgery, it is advised that a maximal safe resection (MSR) should be performed if benefits outweigh risks …”

The Systemic Treatment of Glioma

“…Surgery for high-grade gliomas has the goal of maximum safe resection [49], with prognosis improvement, or at least partial resection or stereotactic biopsy to define histology, as well as molecular markers to drive treatment. Many strategies have been tested to reach maximum safe resection, such as awake surgery, intraoperative magnetic resonance [50], 5-aminolevulinic acid (5-ALA) guide surgery [48], and other techniques that require expertise and facilities to deal with these demands.…”