Survival rates in patients with low‐grade glioma after intraoperative magnetic resonance image guidance

Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
Cancer (Impact Factor: 4.9). 03/2005; 103(6):1227 - 1233. DOI: 10.1002/cncr.20867

No age-adjusted or histologic-adjusted assessments of the association between extent of resection and risk of either recurrence or death exist for neurosurgical patients who undergo resection of low-grade glioma using intraoperative magnetic resonance image (MRI) guidance.METHODS
The current data included 156 patients who underwent surgical resection of a unifocal, supratentorial, low-grade glioma in the MRI suite at Brigham and Women's Hospital between January 1, 1997, and January 31, 2003. Estimates of disease-free and overall survival probabilities were calculated using Kaplan–Meier methodology. The association between extent of resection and these probabilities was measured using a Cox proportional hazards model. Observed death rates were compared with the expected death rate using age-specific and histologic-specific survival rates obtained from the Surveillance, Epidemiology, and End Results Registry.RESULTSPatients who underwent subtotal resection were at 1.4 times the risk of disease recurrence (95% confidence interval [95% CI], 0.7–3.1) and at 4.9 times the risk of death (95% CI, 0.61–40.0) relative to patients who underwent gross total resection. The 1-year, 2-year, and 5-year age-adjusted and histologic-adjusted death rates for patients who underwent surgical resection using intraoperative MRI guidance were 1.9% (95% CI, 0.3–4.2%), 3.6% (95% CI, 0.4–6.7%), and 17.6% (95% CI, 5.9–29.3%), respectively: significantly lower than the rates reported using national data bases.CONCLUSIONS
The data from the current study suggested a possible association between surgical resection and survival for neurosurgical patients who underwent surgery for low-grade glioma under intraoperative MRI guidance. Further study within the context of a large, prospective, population-based project will be needed to confirm these findings. Cancer 2005. © 2005 American Cancer Society.

Download full-text


Available from: Peter Black, Oct 04, 2014
  • Source
    • "All three studies to date using volumetric analysis to determine EOR in low-grade glioma patients (N = 462, range 90–216 patients) have demonstrated a benefit to increasing EOR in univariate and/or in multivariate analysis (Table 4; van Veelen et al., 1998; Claus et al., 2005; Smith et al., 2008). Five-year overall survival was improved in all studies; median survival and time to malignant progression was not always reported. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: There remains no general consensus in the neurosurgical oncology literature regarding the role of extent of glioma resection in improving patient outcome. Although the value of resection in establishing a diagnosis and alleviating mass effect is clear, there is less certainty in ascertaining the influence of extent of resection (EOR). Here, we review the recent literature to synthesize a comprehensive review of the value of extent of resection for gliomas in the modern neurosurgical era. Methods: We reviewed every major peer-reviewed clinical publication since 1990 on the role of EOR in glioma outcome. Results: Thirty-two high-grade glioma articles and 11 low-grade glioma articles were examined in terms of quality of evidence, expected EOR, and survival benefit. Conclusion: Despite limitations in the quality of data, mounting evidence suggests that more extensive surgical resection is associated with longer life expectancy for both low- and high-grade newly diagnosed gliomas.
    Frontiers in Neurology 10/2012; 3:140. DOI:10.3389/fneur.2012.00140
  • Source
    • "The Brain Tumor Society estimates that each year more than 200,000 people in the USA are diagnosed with a primary or metastatic brain tumor. A greater percentage of resection and a smaller volume of postoperative residual tumor are associated with an improved prognosis for the patient [7] [16]. The majority of malignant gliomas recur within 2 cm of the enhancing edge of the original tumor, providing impetus for improved surgical resection. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The modeling of physical processes in biomedical image anal-ysis requires a discretization of the image space into sim-ple shapes like triangles in two dimensions and tetrahedra in three dimensions. These discretizations are known as meshes, and the construction of the meshes as image-to-mesh conversion. There are a number of requirements on image-to-mesh conversion, the most critical of them being the shape of mesh elements in terms of the absence of small angles, the faithful geometrical representation of the tissues by the mesh elements, small number of elements for real-time Finite Element and Finite Volume analysis, and rapid execution times. We present a novel algorithm for triangular and tetrahedral image-to-mesh conversion which allows for guaranteed bounds on the smallest dihedral angle and on the distance between the boundaries of the mesh and the bound-aries of the tissues. The algorithm produces a small number of mesh elements that comply with these bounds. We also describe and evaluate our implementation of the proposed algorithm on two publicly available three-dimensional medi-cal atlases. The implementation is faster than a state-of-the art Delaunay code, and in addition solves the small dihedral angle problem.
  • Source
    • "In both cases, the lesions subsequently underwent rapid transformation into a malignant glioma. Moreover, there remains much debate over the surgical management of low-grade gliomas, the timing of surgery, and the impact of the extent of resection on patient outcome [5] [6] [7] [10] [11] [20] [21] [22] [23] [26] [29] [31] [32] [35] [38] [40] [42] [46] [49]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Low-grade gliomas have been documented to undergo transformation into high-grade astrocytomas, and the time interval of this transformation has been reported to generally occur within 5 years in about 50% of patients harboring these low-grade lesions. Several studies have investigated the evolution of low-grade gliomas into malignant gliomas by CT and MRI characteristics, but many have not documented the timing of these transformation processes. The authors discuss the cases of 2 patients with histopathologically confirmed grade II astrocytomas after craniotomies that underwent rapid evolution into malignant gliomas within 13 weeks. Interestingly, both low-grade astrocytomas were positive with immunostaining for the epidermal growth factor receptor, in which its amplification has been implicated as a molecular marker of malignant gliomas. In addition, the grade II astrocytomas were negative for p53 in both patients but were found to be positive upon transformation into malignant gliomas. To our knowledge, this is the first report of rapid malignant transformation of low-grade gliomas, which were proven by histology, within 13 weeks. There may be patients with a subtype of low-grade astrocytomas that may warrant molecular characterization to determine if aggressive adjuvant therapy would be of benefit.
    World Neurosurgery 01/2010; 73(1):53-62; discussion e5. DOI:10.1016/j.surneu.2009.05.010 · 2.42 Impact Factor
Show more