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: 4.89). 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.

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Available from: Peter Black, Oct 04, 2014
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    • "Others have reported the percentage of patients with ‘gross total tumor removal’ using radiological verification, but with varying definitions, such as “no radiological residual glioma tissue”, “less than 1 cm rim”, and “resection of at least 90% of the preoperative glioma volume” [13]–[15]. Still others have reported the mean EOR [2], [16]. Obviously, one important determinant of EOR is the tumor localization within the brain. "
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    ABSTRACT: Intraoperative brain stimulation mapping reduces permanent postoperative deficits and extends tumor removal in resective surgery for glioma patients. Successful functional mapping is assumed to depend on the surgical team's expertise. In this study, glioma resection results are quantified and compared using a novel approach, so-called resection probability maps (RPM), exemplified by a surgical team comparison, here with long and short experience in mapping. Adult patients with glioma were included by two centers with two and fifteen years of mapping experience. Resective surgery was targeted at non-enhanced MRI extension and was limited by functional boundaries. Neurological outcome was compared. To compare resection results, we applied RPMs to quantify and compare the resection probability throughout the brain at 1 mm resolution. Considerations for spatial dependence and multiple comparisons were taken into account. The senior surgical team contributed 56, and the junior team 52 patients. The patient cohorts were comparable in age, preoperative tumor volume, lateralization, and lobe localization. Neurological outcome was similar between teams. The resection probability on the RPMs was very similar, with none (0%) of 703,967 voxels in left-sided tumors being differentially resected, and 124 (0.02%) of 644,153 voxels in right-sided tumors. RPMs provide a quantitative volumetric method to compare resection results, which we present as standard for quality assessment of resective glioma surgery because brain location bias is avoided. Stimulation mapping is a robust surgical technique, because the neurological outcome and functional-based resection results using stimulation mapping are independent of surgical experience, supporting wider implementation.
    PLoS ONE 09/2013; 8(9):e73353. DOI:10.1371/journal.pone.0073353 · 3.23 Impact Factor
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    • "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. "
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    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
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    • "These include microscopic and MRI enhanced surgery and intraoperative fluorescence-guided surgery, although the latter is not yet clinically available in the United States [3], [4]. In 1997 Black introduced MRI based intraoperative imaging (IOI) as an improvement over microscopic surgery alone [5] and in 1999 Knauth et al. demonstrated that IOI MRI was effective at decreasing tumor burden [6], [7], [8], [9]. More recently, clinical trials in Europe have begun to use fluorescence guided surgical techniques to achieve more complete tumor resections [3]. "
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    PLoS ONE 03/2012; 7(3):e33060. DOI:10.1371/journal.pone.0033060 · 3.23 Impact Factor
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