scholarly journals SURG-21. A CROWDSOURCED CONSENSUS ON SUPRATOTAL RESECTION VERSUS GROSS TOTAL RESECTION FOR ANATOMICALLY DISTINCT PRIMARY GLIOBLASTOMA

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii207-ii208
Author(s):  
Debraj Mukherjee ◽  
Maureen Rakovec ◽  
Chetan Bettegowda ◽  
Christopher Jackson ◽  
Gary Gallia ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Fellowship Training ◽  
Gross Total Resection ◽  
Total Resection ◽  
Consensus Definition ◽  
Post Contrast ◽  
Primary Glioblastoma ◽  
Treatment Plans ◽  
Strongly Agree ◽  
Supratotal Resection

Abstract Gross total resection (GTR) of contrast-enhancing tumor is associated with significantly increased overall survival in primary glioblastoma (GBM). Even when achieved, recurrence is likely, in part due to malignant cells infiltrating outside enhanced regions. Subsequently, there has been increasing interest in performing supratotal resections (SpTRs) for GBM. Published results have varied in part due to a lack of consensus on the definition of SpTR in GBM and its appropriate use. A crowdsourcing approach was used to survey 21 academic neurosurgical oncologists representing 13 health systems nationwide. Participants’ demographics including fellowship training status, years of experience, and operative volume with various techniques was collected. Participants were presented with 11 definitions of SpTR from published, peer-reviewed studies and asked to rate the appropriateness of each definition. Subsequently, participants reviewed T1-weighed post-contrast and FLAIR MR imaging videos in the axial, coronal, and sagittal planes for 22 GBMs. Participants were asked to assess eloquence of the tumor’s location, perceived equipoise of enrolling patients in a randomized clinical trial comparing GTR to SpTR, and their own personal surgical treatment plans. Most neurosurgeons surveyed (n=18, 85.7%) agree or strongly agree that GTR plus resection of some non-contrast enhancement is an appropriate definition for SpTR. Overall, there was only moderate inter-rater agreement, measured using sample variance and the index of qualitative variation, regarding eloquence, equipoise, and personal treatment plans. Neurosurgeons who performed more than 10 SpTRs for GBMs in the past year were more likely than counterparts to recommend it as their personal treatment plan (p< 0.005). Anterior temporal and right frontal GBMs were considered the best randomization candidates. We established a consensus definition for SpTR of GBM and identified anatomically distinct locations deemed most amenable to SpTR. These results will be used to plan prospective trials further investigating the potential clinical utility of SpTR for GBMs.

scholarly journals A Consensus Definition of Supratotal Resection for Anatomically Distinct Primary Glioblastoma: An AANS/CNS Section on Tumors Survey of Neurosurgical Oncologists

2021 ◽  
Author(s):  
Maureen Rakovec ◽  
Adham M. Khalafallah ◽  
Oren Wei ◽  
David Day ◽  
Jason P. Sheehan ◽  
...  
Keyword(s):  
Contrast Enhancement ◽  
Resonance Imaging ◽  
Consensus Definition ◽  
Primary Glioblastoma ◽  
Temporal Lobes ◽  
Tumor Section ◽  
Treatment Plans ◽  
Definition Of ◽  
The Right ◽  
Supratotal Resection

Abstract Introduction: Supratotal resection (SpTR) of glioblastoma may be associated with improved survival, but published results have varied in part from lack of consensus on the definition and appropriate use of SpTR. A previous small survey of neurosurgical oncologists with expertise performing SpTR found resection 1-2 cm beyond contrast enhancement was an acceptable definition and glioblastoma involving the right frontal and bilateral anterior temporal lobes were considered most amenable to SpTR. The general neurosurgical oncology community has not yet confirmed the practicality of this definition. Methods Seventy-six general neurosurgical oncology members of the AANS/CNS Tumor Section were surveyed using a crowdsourcing approach. Participants were presented with 11 definitions of SpTR and rated each definition’s appropriateness. Participants additionally reviewed magnetic resonance imaging for 10 anatomically distinct glioblastomas and assessed the tumor location's eloquence, perceived equipoise of enrolling patients in a randomized trial comparing gross total to SpTR, and their personal treatment plans. Results Fifty-two neurosurgeons (73.2%) agreed that resection 1-2 cm beyond contrast enhancement was an acceptable definition for SpTR. Cases were divided into three anatomically distinct groups by perceived equipoise between gross total and SpTR. The best clinical trial candidates were right anterior temporal (n=58, 76.3%) and right frontal (n=55, 73.3%) glioblastomas. Conclusion Support exists within the neurosurgical oncology community to adopt the proposed consensus definition of SpTR of glioblastoma and to treat right anterior temporal and right frontal glioblastomas using SpTR. A smaller proportion of general neurosurgical oncologists than SpTR experts consider SpTR feasible in the left anterior temporal lobe.

scholarly journals Letter: A Crowdsourced Consensus on Supratotal Resection Versus Gross Total Resection for Anatomically Distinct Primary Glioblastoma

Neurosurgery ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jose Pedro Lavrador ◽  
Asfand Baig Mirza ◽  
Prajwal Ghimire ◽  
Richard Gullan ◽  
Francesco Vergani ◽  
...  
Keyword(s):  
Gross Total Resection ◽  
Total Resection ◽  
Primary Glioblastoma ◽  
Supratotal Resection

scholarly journals SURG-16. SUPRATOTAL VERSUS GROSS TOTAL RESECTION OF GLIOBLASTOMA: A SYSTEMATIC REVIEW

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi243-vi243
Author(s):  
Christina Jackson ◽  
John Choi ◽  
Carrie Price ◽  
Chetan Bettegowda ◽  
Michael Lim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Gross Total Resection ◽  
Cochrane Library ◽  
Study Quality ◽  
Total Resection ◽  
Significant Difference ◽  
Definition Of ◽  
Supratotal Resection ◽  
The Cochrane Library

Abstract INTRODUCTION Due to the infiltrative nature of glioblastoma(GBM) outside of the contrast enhancing region in the peritumoral zone, there is increasing movement to perform supratotal resections (SpTR) by extending the edge of resection beyond the contrast enhancing portion of the tumor. However, there is currently no consensus on the potential survival benefit of SpTR in GBM as compared to gross total resection (GTR). METHODS Therefore, we performed a systematic review using PRISMA guidelines and performed a comprehensive literature search on Pubmed, EMBASE, The Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov, from inception to August 16, 2018, to identify articles comparing overall survival (OS) after SpTR versus GTR. Furthermore, we assessed study quality using the Oxford Centre for Evidence-Based Medicine guidelines. RESULTS We identified 8902 unique citations, of which 11 articles and 2 abstracts met study inclusion criteria. 925 patients underwent SpTR out of a total of 2137 patients. 9 of the 13 studies demonstrated improved survival with SpTR compared to GTR (median improvement in OS of 10.5 months), with no significant difference in post-operative complication rate. Conversely, one abstract found worsened outcomes with SpTR compared to GTR (median decrease in OS of 4 months). However, overall study quality was poor, with 12 of the 13 studies of level IV evidence and one study of level IIIb evidence. We were unable to perform a meta-analysis due to significant clinical and methodological heterogeneity amongst the studies (e.g. differences in adjuvant therapy and lack of standardization of definition of supratotal resection). CONCLUSIONS Our systematic review indicates that SpTR may be associated with improved OS compared to GTR for GBM. However, this is limited by poor study quality and significant clinical and methodological heterogeneity amongst the studies. There is need for prospective clinical trials to further establish standardized guidelines for SpTR in GBM.

scholarly journals SURG-08. SURVIVAL BENEFIT OF LOBECTOMY FOR PRIMARY GLIOBLASTOMAS IN NON-ELOQUENT REGION: GROSS-TOTAL RESECTION VERSUS SUPRATOTAL RESECTION

2018 ◽  
Vol 20 (suppl_6) ◽  
pp. vi252-vi252
Author(s):  
Minkyun Na ◽  
Tae Hoon Roh ◽  
Ju Hyung Moon ◽  
Eui Hyun Kim ◽  
Seok-Gu Kang ◽  
...  
Keyword(s):  
Survival Benefit ◽  
Gross Total Resection ◽  
Total Resection ◽  
Supratotal Resection ◽  
Primary Glioblastomas

scholarly journals STMO-6 Impact of the extent of resection on the survival of patients with lower grade gliomas using awake brain mapping

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi12-vi13
Author(s):  
Kazuya Motomura ◽  
Lushun Chalise ◽  
Fumiharu Ohka ◽  
Kosuke Aoki ◽  
Tomohide Nishikawa ◽  
...  
Keyword(s):  
Brain Mapping ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Lower Grade ◽  
Wild Type ◽  
Total Resection ◽  
Mutant Type ◽  
Who Grade ◽  
Supratotal Resection

Abstract Purpose: The aim of this study was to assess the effect of the extent of resection (EOR) of tumors on survival in a series of patients with lower-grade gliomas (LGGs) who underwent awake brain mapping. Methods: We retrospectively analyzed 126 patients with LGGs in the dominant and non-dominant hemisphere who underwent awake brain surgery at the same institution between December 2012 and May 2020. Results: The median progression-free survival (PFS) rate of patients with LGGs in the group with an EOR >100 %, including supratotal resection (n = 47; median survival [MS], not reached), was significantly higher than that in the group with an EOR <100% (n = 79; MS, 43.1 months; 95% CI: 37.8–48.4 months; p = 0.04). In patients with diffuse astrocytomas and anaplastic astrocytomas, the group with EOR >100 %, including supratotal resection (n = 25; MS, not reached), demonstrated a significantly better PFS rate than did the group with an EOR <100% (n = 45; MS, 35.8 months; 95% CI: 19.9–51.6 months; p = 0.03). Supratotal or gross total resection was correlated with better PFS in IDH-mutant type of diffuse astrocytomas and anaplastic astrocytomas (n = 19; MS, not reached vs. n = 35; MS, 40.6 months; 95% CI: 22.3–59.0 months; p = 0.02). By contrast, supratotal or gross total resection was not associated with longer PFS rates in patients with IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas. Conclusions: It is noteworthy that supratotal or gross total resection significantly correlated with better PFS in IDH-mutant type of WHO grade II and III astrocytic tumors. In light of our finding that EOR did not correlate with PFS in patients with aggressive IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas, we suggest treatments that are more intensive will be needed for the control of these tumors.

scholarly journals Impact of the extent of resection on the survival of patients with lower-grade gliomas using awake brain mapping

2021 ◽  
Author(s):  
Kazuya Motomura ◽  
Lushun Chalise ◽  
Fumiharu Ohka ◽  
Kosuke Aoki ◽  
Kuniaki Tanahashi ◽  
...  
Keyword(s):  
Brain Mapping ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Lower Grade ◽  
Wild Type ◽  
Total Resection ◽  
Mutant Type ◽  
Who Grade ◽  
Supratotal Resection

Abstract PurposeThe aim of this study was to assess the effect of the extent of resection (EOR) of tumors on survival in a series of patients with lower-grade gliomas (LGGs) who underwent awake brain mapping.MethodsWe retrospectively analyzed 126 patients with LGGs in the dominant and non-dominant hemisphere who underwent awake brain surgery at the same institution between December 2012 and May 2020.ResultsThe median progression-free survival (PFS) rate of patients with LGGs in the group with an EOR > 100 %, including supratotal resection (n = 47; median survival [MS], not reached), was significantly higher than that in the group with an EOR < 100% (n = 79; MS, 43.1 months; 95% CI: 37.8–48.4 months; p = 0.04). In patients with diffuse astrocytomas and anaplastic astrocytomas, the group with EOR > 100 %, including supratotal resection (n = 25; MS, not reached), demonstrated a significantly better PFS rate than did the group with an EOR < 100% (n = 45; MS, 35.8 months; 95% CI: 19.9–51.6 months; p = 0.03). Supratotal or gross total resection was correlated with better PFS in IDH-mutant type of diffuse astrocytomas and anaplastic astrocytomas (n = 19; MS, not reached vs. n = 35; MS, 40.6 months; 95% CI: 22.3–59.0 months; p = 0.02). By contrast, supratotal or gross total resection was not associated with longer PFS rates in patients with IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas. ConclusionsIt is noteworthy that supratotal or gross total resection significantly correlated with better PFS in IDH-mutant type of WHO grade II and III astrocytic tumors. In light of our finding that EOR did not correlate with PFS in patients with aggressive IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas, we suggest treatments that are more intensive will be needed for the control of these tumors.

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

2020 ◽  
Vol 132 (3) ◽  
pp. 895-901 ◽  
Author(s):  
Tae Hoon Roh ◽  
Seok-Gu Kang ◽  
Ju Hyung Moon ◽  
Kyoung Su Sung ◽  
Hun Ho Park ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Survival Benefit ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Progression Free Survival ◽  
Gross Total Resection ◽  
Total Resection ◽  
Analysis Survival ◽  
The Right ◽  
Supratotal Resection

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.

Lobectomy confers a survival benefit over gross-total resection without lobectomy in cases of primary glioblastoma in non-eloquent area: A retrospective study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13561-e13561
Author(s):  
Euihyun Kim
Keyword(s):  
Overall Survival ◽  
Retrospective Study ◽  
Survival Benefit ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Progression Free Survival ◽  
Gross Total Resection ◽  
Total Resection ◽  
Primary Glioblastoma ◽  
Eloquent Area

e13561 Background: Following resection, the microscopic remnants of glioblastomas in nearby tissue cause tumor recurrence more often than other tumors. Although surgical oncologists traditionally resect some of the surrounding normal tissue, whether further removal of nearby tissue may improve survival in cases of primary glioblastomas (pGBM) is unknown. In this single-center retrospective study, we assessed whether lobectomy confers a survival benefit over gross-total resection without lobectomy when treating pGBM in the non-eloquent area. Methods: We selected 28 patients who had complete resection of a histopathologically-diagnosed pGBM in the right frontal or temporal lobe, and divided them into two groups according to whether gross-total resection of the tumor involved lobectomy (SupTR group, n = 15) or did not (GTR group, n = 13). Progression-free survival (PFS), overall survival (OS), and Karnofsky Performance Status (KPS) scores were compared statistically between groups (p≤0.05 for significant differences). Results: Median post-operative PFS times (GTR, 9.7 months [95% CI 2.9-16.5]; SupTR, 35.0 months [95% CI 11.1–58.9]; p = 0.082) and mean KPS scores (GTR, 73.4; SupTR, 71.3; p = 0.586) were not significantly different; however, median post-operative OS times were (GTR, 14.4 months [95% CI 12.1–16.7]; SupTR, 35.0 months [95% CI 17.4–52.6]; p = 0.018). In multivariate analysis, the SupTR group was significantly better than the GTR group in terms of both OS (HR 0.249; 95% CI 0.085–0.730; p = 0.011) and PFS (HR 0.362; 95% CI 0.0134–0.982; p = 0.046). Conclusions: In cases of completely resectable, non-eloquent area pGBMs, including lobectomy improved overall survival without negatively impacting patient performance.

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