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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    • "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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