Survival benefit of lobectomy over gross-total resection without lobectomy in cases of glioblastoma in the noneloquent area: a retrospective study

Abstract

OBJECTIVEFollowing resection of glioblastoma (GBM), microscopic remnants of the GBM tumor remaining in nearby tissue cause tumor recurrence more often than for other types of tumors, even after gross-total resection (GTR). Although surgical oncologists traditionally resect some of the surrounding normal tissue, whether further removal of nearby tissue may improve survival in GBM patients is unknown. In this single-center retrospective study, the authors assessed whether lobectomy confers a survival benefit over GTR without lobectomy when treating GBMs in the noneloquent area.METHODSThe authors selected 40 patients who had undergone GTR of a histopathologically diagnosed isocitrate dehydrogenase (IDH)–wild type GBM in the right frontal or temporal lobe and divided the patients into 2 groups according to whether GTR of the tumor involved lobectomy, defined as a supratotal resection (SupTR group, n = 20) or did not (GTR group, n = 20). Progression-free survival (PFS), overall survival (OS), and Karnofsky Performance Status (KPS) scores were compared between groups (p ≤ 0.05 for statistically significant differences).RESULTSThe median postoperative PFS times for each group were as follows: GTR group, 11.5 months (95% CI 8.8–14.2) and SupTR group, 30.7 months (95% CI 4.3–57.1; p = 0.007). The median postoperative OS times for each group were as follows: GTR group, 18.7 months (95% CI 14.3–23.1) and SupTR group, 44.1 months (95% CI 25.1–63.1; p = 0.040). The mean postoperative KPS scores (GTR, 76.5; SupTR, 77.5; p = 0.904) were not significantly different. In multivariate analysis, survival for the SupTR group was significantly longer than that for the GTR group in terms of both PFS (HR 0.230; 95% CI 0.090–0.583; p = 0.002) and OS (HR 0.247; 95% CI 0.086–0.704; p = 0.009).CONCLUSIONSIn cases of completely resectable, noneloquent-area GBMs, SupTR provides superior PFS and OS without negatively impacting patient performance.

Association Between Supratotal Glioblastoma Resection and Patient Survival: A Systematic Review and Meta-Analysis

“…Additionally, a very recent study defined SPTR as GTR plus frontal or temporal lobectomy, without any volumetric analysis on the T2-weighted FLAIR volumes or functionally defined borders during awake surgery. 34 Therefore, based on the reported data, SPTR can only broadly be defined as every effort of resection after GTR of the CE portion of GBM. No standardized definition of SPTR exists; thus, SPTR needs to be defined in a prospective setting.…”

Genetic characterization of stem cell-like cancer cell in the peri-tumoral regions and proliferative lymphocyte in the peripheral blood of patients with glioblastoma

“…However, conclusions derived from these cells could be modestly generalized to GBM cells outside C regions as well as recurrent GBM cells, as many studies have revealed great differences between them, such as responses to irradiation, temozolomide, and lomustine 3, 4, 7, 11, 45 . On the other hand, many studies have showed that additional resection beyond total contrast-enhancing resection could favor patients’ outcomes 14, 15 . Therefore, it is of vital prognostic and therapeutic significance to investigate the GBM cells in P and N regions directly to develop novel post-operative treatment for GBM patients.…”

“…For instance, Yan Michael Li and colleagues showed that additional resection of the surrounding T2/FLAIR abnormality beyond total contrast-enhancing resection prolonged median survival time of GBM patients 14 . In addition, lobectomy of GBM in non-eloquent areas benefited patients in both overall survival (OS) and progression-free survival (PFS) 15 . Furthermore, Hanna Mendes Levitin and colleagues identified GBM cells from the non-enhancing GBM margin, and revealed that the expression signature biased toward infiltrated GBM cells was negatively correlated with patients’ survival 16 .…”

Glioblastoma Cellular Origin and the Firework Pattern of Cancer Genesis from the Subventricular Zone

“…An epiphany came from the experience of 5-aminolevulinic acid (5-ALA) fluorescence without any tumor cells in the tumor specimen by pathologic examinations 45) . During surgery to remove GBM, high fluorescence of 5-ALA was found in the walls of ventricles 45) , which are non-coincidentally exposed after supra-total resection (or a so-called planned lobectomy) 52,53) . Moon et al 45) described interesting patterns of 5-ALA fluorescence in the ventricular wall of brain tumor patients.…”

“…Isocitrate dehydrogenase (IDH)-wildtype glioblastoma (GBM) is a disease with a dismal prognosis, a distinction that has led to GBM being dubbed the "emperor of all cancers". The disease progression is rapid, and even with standard therapy 53) and supra-total resection 52) , the median survival of patients from diagnosis is approximately 14-20 months 53,63) .…”