Surgical resection versus watchful waiting in low-grade gliomas

Jakola, Asgeir Store; Skjulsvik, Anne Jarstein; Myrmel, Kristin Smistad; Sjåvik, Kristin; Unsgård, Geirmund; Torp, Sverre Helge; Aaberg, Kari Modalsli; Berg, Thomas; Dai, Hong; Johnsen, Knut; Kloster, Roar; Solheim, Ole

doi:10.1093/annonc/mdx230

Cited by 239 publications

(161 citation statements)

References 34 publications

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“…37 Interestingly, we did not see a clear divergence of survival curves between young high-risk patients (below 40 years) and highrisk patients aged 40-49 years in our study. 3 Hence, a cutoff at 50 years seems more reasonable to select high-risk patients for early postoperative treatment, 1,40 to accurately balance the long-term risks against the benefits of treatment and to avoid overtreatment in long-term survivors. This is consistent with the findings from the UCSF group that used 50 years as a threshold.…”

Section: Discussionmentioning

confidence: 99%

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Age and surgical outcome of low-grade glioma in Sweden

et al. 2018

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Section: Discussionmentioning

confidence: 99%

“…This is consistent with the findings from the UCSF group that used 50 years as a threshold. 3 Hence, a cutoff at 50 years seems more reasonable to select high-risk patients for early postoperative treatment, 1,40 to accurately balance the long-term risks against the benefits of treatment and to avoid overtreatment in long-term survivors.…”

Section: Discussionmentioning

confidence: 99%

Age and surgical outcome of low-grade glioma in Sweden

et al. 2018

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“…An early follow-up found an overall survival benefit for patients treated with early surgical resection compared with those managed with biopsy and watchful waiting [16]. versus region A (14.4 years vs. 5.8 years, p < .01) [17]. These studies did not evaluate disease-specific survival, but they found that overall survival was similar to diseasespecific survival among patients with primary brain tumors (approximate 2% difference) in the Norwegian population [18].…”

Section: Gliomasmentioning

confidence: 98%

Magnetic Resonance Imaging-Based Screening for Asymptomatic Brain Tumors: A Review

et al. 2018

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Brain tumors comprise 2% of all cancers but are disproportionately responsible for cancer‐related deaths. The 5‐year survival rate of glioblastoma, the most common form of malignant brain tumor, is only 4.7%, and the overall 5‐year survival rate for any brain tumor is 34.4%. In light of the generally poor clinical outcomes associated with these malignancies, there has been interest in the concept of brain tumor screening through magnetic resonance imaging. Here, we will provide a general overview of the screening principles and brain tumor epidemiology, then highlight the major studies examining brain tumor prevalence in asymptomatic populations in order to assess the potential benefits and drawbacks of screening for brain tumors. Implications for Practice Magnetic resonance imaging (MRI) screening in healthy asymptomatic adults can detect both early gliomas and other benign central nervous system abnormalities. Further research is needed to determine whether MRI will improve overall morbidity and mortality for the screened populations and make screening a worthwhile endeavor.

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“…In the lack of randomization, propensity matching can, for example be, done to limit selection bias [16]. Also, differences in favored treatments between centers may enable pseudorandomized trials [11]. Collection of prospective data, for example within treatment registries may enable parallel cohort studies or pragmatic trials with sufficient statistical power.…”

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confidence: 99%

Randomized controlled trials in surgery and the glass ceiling effect

Solheim

2019

Acta Neurochir

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Richard Horton ridiculed over primitive surgical research methods in a famous commentary in the Lancet more than two decades ago [9]. Surgical research was compared with a comic opera-where questions are shouted out, but without answers. Horton stated BI should like to shame [surgeons] out of the comic opera performances which they suppose are statistics of operations.^The dominating study method in neurosurgery, namely retrospective series of surgeons evaluating their own work is often hopelessly biased and the scientific value may certainly be questioned. Without well-conducted randomized controlled trials (RCTs), can we really advance and know what works and what does not? And before we discuss the optimal surgical management, do we really know that surgery helps at all? Surgery has traditionally been more experience based than evidence based, and much of the enormous advancements in of surgical treatment over the last 200 years have taken place without rigorous scientific trials [6]. Still, there are several thought-provoking examples of surgical interventions that have failed the test of a sham-controlled randomized trial, for example arthroscopic knee surgery for degenerative osteoarthrosis or meniscal tears [15,20], subacromial decompression for shoulder impingement [17], diaphragm pacing in ALS [7], deep brain stimulation in the ventral capsule/ventral striatum for depression [5], renal denervation for hypertension [1], and vertebroplasty for osteoporotic vertebral fractures [2]. In fact, an overwhelming majority of sham-controlled trials in surgery fail to demonstrate an effect of the intervention [18]. Does this mean that surgery often is less effective than we like to believe? Or does it merely reflect the fact that few surgical interventions can be placebo controlled and that such trials are more often done when the likelihood of surgery being an effective treatment is low in the first place? Nevertheless, very few surgical treatments have been placed under the scrutiny of such trials and many operations are still backed by relative scarce and often conflicting evidence, not at least in neurosurgery.Martin and colleagues [14] conducted an interesting and well-written systematic review with critical appraisal of RCTs that compare neurosurgical interventions with nonoperative therapy. They identified 82 neurosurgical RCTs published between 2000 and 2017. More than a third of the trials found a difference between operative and non-operative treatment, but in less than 4% non-operative management was found to be superior. However, most trials were conducted by surgeons, and this can be a source of bias as the genealogy of scientist may have an impact on their findings [8]. Further, high JADAD score, reflecting better methodological quality [10], was associated with lower chance of demonstrating a benefit from surgery. The JADAD scale places much emphasis on blinding and the inter-rater agreement for the JADAD scale has been questioned [3]. Still, almost half of the neurosurgical studies in the current rev...

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Surgical resection versus watchful waiting in low-grade gliomas

Cited by 239 publications

References 34 publications

Age and surgical outcome of low-grade glioma in Sweden

Age and surgical outcome of low-grade glioma in Sweden

Magnetic Resonance Imaging-Based Screening for Asymptomatic Brain Tumors: A Review

Randomized controlled trials in surgery and the glass ceiling effect

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