What is the advance of extent of resection in glioblastoma surgical treatment—a systematic review

Wang, Lei; Liang, Buqing; Li, Yan Icy; Liu, Xiang; Huang, Jason H.; Li, Yan Michael

doi:10.1186/s41016-018-0150-7

Cited by 19 publications

(15 citation statements)

References 59 publications

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“…Surgical morbidity will also be lower. Complete resection in surgery is not always feasible because of the location of the tumour and involvement of critical neurovascular structures that may compromise the patient's functional outcome if injured [41]. We previously reported that ATR-FTIR can also help discriminate tumour sub-types [30], so for patients with tumours in eloquent brain regions not suitable for resection, liquid biopsy may obviate the need for, and risk of, surgery.…”

Section: Discussionmentioning

confidence: 99%

Rapid Spectroscopic Liquid Biopsy for the Universal Detection of Brain Tumours

Theakstone

Brennan

Jenkinson

et al. 2021

Cancers

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Background: To support the early detection and diagnosis of brain tumours we have developed a rapid, cost-effective and easy to use spectroscopic liquid biopsy based on the absorbance of infrared radiation. We have previously reported highly sensitive results of our approach which can discriminate patients with a recent brain tumour diagnosis and asymptomatic controls. Other liquid biopsy approaches (e.g., based on tumour genetic material) report a lower classification accuracy for early-stage tumours. In this manuscript we present an investigation into the link between brain tumour volume and liquid biopsy test performance. Methods: In a cohort of 177 patients (90 patients with high-grade glioma (glioblastoma (GBM) or anaplastic astrocytoma), or low-grade glioma (astrocytoma, oligoastrocytoma and oligodendroglioma)) tumour volumes were calculated from magnetic resonance imaging (MRI) investigations and patients were split into two groups depending on MRI parameters (T1 with contrast enhancement or T2/FLAIR (fluid-attenuated inversion recovery)). Using attenuated total reflection (ATR)-Fourier transform infrared (FTIR) spectroscopy coupled with supervised learning methods and machine learning algorithms, 90 tumour patients were stratified against 87 control patients who displayed no symptomatic indications of cancer, and were classified as either glioma or non-glioma. Results: Sensitivities, specificities and balanced accuracies were all greater than 88%, the area under the curve (AUC) was 0.98, and cancer patients with tumour volumes as small as 0.2 cm3 were correctly identified. Conclusions: Our spectroscopic liquid biopsy approach can identify gliomas that are both small and low-grade showing great promise for deployment of this technique for early detection and diagnosis.

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Section: Discussionmentioning

confidence: 99%

Rapid Spectroscopic Liquid Biopsy for the Universal Detection of Brain Tumours

Theakstone

Brennan

Jenkinson

et al. 2021

Cancers

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“…Extent surgical resection is known to be independently associated with survival outcomes of patients with glioblastoma [ 34 ]. Therefore, we next investigated the impact of GTR or STR on NKA, absolute NK cell counts, and distribution of NK and T cell subsets.…”

Section: Resultsmentioning

confidence: 99%

Gross Total Resection Promotes Subsequent Recovery and Further Enhancement of Impaired Natural Killer Cell Activity in Glioblastoma Patients

et al. 2022

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Glioblastoma is the most common primary malignant brain tumor, and median survival is relatively short despite aggressive standard treatment. Natural killer (NK) cell dysfunction is strongly associated with tumor recurrence and metastasis but is unclear in glioblastoma. NK activity (NKA) represents NK cell-secreted interferon-γ (IFN-γ), which modulates immunity and inhibits cancer progression. This study aimed to analyze NKA in glioblastoma patients to obtain a clearer overview of immunity surveillance. From 2020 to 2021, a total of 20 patients and six healthy controls were recruited. Peripheral blood samples were collected preoperatively and on postoperative days (POD) 3 and 30. Then, NKA was measured using the NK VUE kit. Although NKA decreased on POD3, it recovered and further significantly enhanced on POD30, with a nearly five-fold increase compared to baseline (p = 0.004). Furthermore, the percentage of CD56brightCD16− NK cells decreased significantly on POD3 (p = 0.022) and further recovered on PO30. Subgroup analysis of extent surgical resection further revealed that the recovery of impaired NKA was attributable to gross total resection (GTR) rather than subtotal resection (STR). In conclusion, NKA is significantly impaired in glioblastoma, and GTR has demonstrated superior benefit in improving the suppressed NKA and increased CD56brightCD16− NK subset in glioblastoma patients, which may be associated with subsequent patients’ prognosis. Therefore, the goal of performing GTR for glioblastoma should be achieved when possible since it appears to increase NKA cell immunity.

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“…Numerous studies have now shown that progression-free survival and overall survival can be improved with increasing the extent of resection. [16][17][18][19][20][21] Conversely, permanent neurological deficit from surgery can instantaneously negate any benefit from a surgical intervention and cause permanent harm. Our current practice takes a multimodal approach toward maximum safe resection.…”

Section: Discussionmentioning

confidence: 99%

A Novel 5-Aminolevulinic Acid-Enabled Surgical Loupe System—A Consecutive Brain Tumor Series of 11 Cases

Zhang

Jaman

Habib

et al. 2022

Operative Neurosurgery

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BACKGROUND:The concept of maximally safe resection (MSR) has been shown to improve clinical outcomes in the treatment of high-grade gliomas (HGGs). To achieve MSR, surgical adjuncts such as functional imaging, neuronavigation, intraoperative mapping, ultrasound, and fluorescence-guided surgery are routinely used. 5-Aminolevulinic acid (5-ALA) is an oral agent that has been increasingly adopted in fluorescence-guided resection of HGG. In randomized clinical trials of 5-ALA, it has been shown to increase the extent of resection and progression-free survival in HGG. Current commercially available 5-ALA detection systems are all microscope-based and can sometimes be cumbersome to use.OBJECTIVE:To present our experience using a novel 5-ALA–enabled surgical loupe system.METHODS:5-ALA–enabled loupes were used in 11 consecutive patients with either suspected HGG on magnetic resonance imaging or recurrence of known lesions. Lesion appearance was examined under white light, 5-ALA loupes, and a 5-ALA microscope. Tumor specimens were checked for fluorescence and sent for pathologic examination.RESULTS:In our experience, a 5-ALA–enabled surgical loupe system offers excellent visualization of 5-ALA in patients with HGG. In 10 of 11 patients, fluorescent tissue was confirmed to be high-grade glioma by pathology. In 1 patient, tissue was not fluorescent, and final pathology was World Health Organization grade I meningioma.CONCLUSION:A 5-ALA–enabled surgical loupe system offers excellent intraoperative visualization of 5-ALA fluorescence in HGG and can be a viable surgical adjunct for achieving MSR of HGG.

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What is the advance of extent of resection in glioblastoma surgical treatment—a systematic review

Cited by 19 publications

References 59 publications

Rapid Spectroscopic Liquid Biopsy for the Universal Detection of Brain Tumours

Rapid Spectroscopic Liquid Biopsy for the Universal Detection of Brain Tumours

Gross Total Resection Promotes Subsequent Recovery and Further Enhancement of Impaired Natural Killer Cell Activity in Glioblastoma Patients

A Novel 5-Aminolevulinic Acid-Enabled Surgical Loupe System—A Consecutive Brain Tumor Series of 11 Cases

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