Supratentorielle Gliome: Analyse klinischer und zeitlicher Parameter in 163 Fällen

Abstract

163 cases of supratentorial astrocytomas and glioblastomas were evaluated retrospectively after close-meshed observation and treatment. We attached the greatest importance to the reevaluation of already known prognostic parameters and to the temporal analysis of the course of gliomas. We could confirm the influence of the histologic grade on the survival time. Histologic grading by means of immunohistochemistry proved to be more precise than grading only by means of HE staining. Furthermore, the patient's age was one of the most important prognostic variables for survival time after operation. Other factors were the first preoperative Karnofsky rating, the preoperative diameter of the tumour, the duration of preoperative symptoms and the interval between operation and diagnosis of tumour recurrence as well as between tumour recurrence and reoperation. Epileptic seizures as preoperative symptoms were found to be far less prognostic for survival time. Localisation of the tumour, other preoperative symptoms, Karnofsky rating before reoperation and the extent of tumour resection proved to be of no importance for survival time.

The Value of Glioma Extent of Resection in the Modern Neurosurgical Era

“…Thirty-two studies were identified between 1990 and 2012 examining EOR and high-grade glioma patient outcomes (Shibamoto et al, 1990; Vecht et al, 1990; Hollerhage et al, 1991; Phillips et al, 1991; Sandberg-Wollheim et al, 1991; Curran et al, 1992; Duncan et al, 1992; Prados et al, 1992; Dinapoli et al, 1993; Huber et al, 1993; Simpson et al, 1993; Jeremic et al, 1994; Warnke et al, 1994; Nitta and Sato, 1995; Barker et al, 1996; Kowalczuk et al, 1997; Keles et al, 1999, 2006; Buckner et al, 2001; Lacroix et al, 2001; Levin et al, 2002; Puduvalli et al, 2003; Tortosa et al, 2003; Lamborn et al, 2004; Brown et al, 2005; Pope et al, 2005; Stark et al, 2005; Ushio et al, 2005; Nomiya et al, 2007). Most, but not all, studies used standard WHO grading criteria; other grading systems were utilized in a minority of reports (Dinapoli et al, 1993; Levin et al, 2002; Stark et al, 2005).…”

“…Of note, four studies found EOR to only be associated with increased patient survival in multivariate analysis, but not univariate analysis. Conversely, 11 non-volumetric studies ( N  = 1800, range 75–357 patients) demonstrated no overall survival benefit associated with increased EOR using either univariate or multivariate analysis (Table 3; Hollerhage et al, 1991; Phillips et al, 1991; Sandberg-Wollheim et al, 1991; Duncan et al, 1992; Prados et al, 1992; Huber et al, 1993; Kowalczuk et al, 1997; Levin et al, 2002; Puduvalli et al, 2003; Tortosa et al, 2003; Oszvald et al, 2012). Potential confounders such as use of chemotherapy and radiation therapy varied widely between publications, but did not differ significantly among patients receiving greater or lesser EOR in any individual series.…”

Resección de lesiones cerebrales con asistencia de mapeo cortical intraoperatorio

“…Si bien la mayoría de las comunicaciones sobre resección de gliomas de alto grado muestra benefi cio en la sobrevida 2,6,20,[33][34][35][36][37][38][39][40][41][42][43][44][45][46] , algunos trabajos no encuentran benefi cio signifi cativo [47][48][49][50][51][52][53][54][55][56] .…”

Emerging operative strategies in neurosurgical oncology

“…Seventeen nonvolumetric extent of resection studies (n ¼ 4992, range 86-949 patients) demonstrated a survival benefit associated with increased extent of resection using univariate or multivariate analyses) [3][4][5][6][7]11,16,18,19,25,26,28,30,31,[33][34][35]. Conversely, 11 nonvolumetric studies (n ¼ 1800, range 75-357 patients) demonstrated no overall survival benefit associated with increased extent of resection using either univariate or multivariate analysis [8][9][10]14,17,20,[22][23][24]29,34]. Of the 14 studies that utilized multivariate analysis to control for age, performance status, and use of adjuvant therapy, only one such analysis [6] subsequently rendered extent of resection nonsignificant.…”