Role of Extent of Resection in the Long-Term Outcome of Low-Grade Hemispheric Gliomas

Department of Neurological Surgery, Brain Tumor Research Center, University of California San Francisco, 505 Parnassus Ave, Room M-779, San Francisco, CA 94143-0112, USA.
Journal of Clinical Oncology (Impact Factor: 18.43). 04/2008; 26(8):1338-45. DOI: 10.1200/JCO.2007.13.9337
Source: PubMed
The prognostic role of extent of resection (EOR) of low-grade gliomas (LGGs) is a major controversy. We designed a retrospective study to assess the influence of EOR on long-term outcomes of LGGs.
The study population (N = 216) included adults undergoing initial resection of hemispheric LGG. Region-of-interest analysis was performed to measure tumor volumes based on fluid-attenuated inversion-recovery (FLAIR) imaging.
Median preoperative and postoperative tumor volumes and EOR were 36.6 cm(3) (range, 0.7 to 246.1 cm(3)), 3.7 cm(3) (range, 0 to 197.8 cm(3)) and 88.0% (range, 5% to 100%), respectively. There was no operative mortality. New postoperative deficits were noted in 36 patients (17%); however, all but four had complete recovery. There were 34 deaths (16%; median follow-up, 4.4 years). Progression and malignant progression were identified in 95 (44%) and 44 (20%) cases, respectively. Patients with at least 90% EOR had 5- and 8-year overall survival (OS) rates of 97% and 91%, respectively, whereas patients with less than 90% EOR had 5- and 8-year OS rates of 76% and 60%, respectively. After adjusting each measure of tumor burden for age, Karnofsky performance score (KPS), tumor location, and tumor subtype, OS was predicted by EOR (hazard ratio [HR] = 0.972; 95% CI, 0.960 to 0.983; P < .001), log preoperative tumor volume (HR = 4.442; 95% CI, 1.601 to 12.320; P = .004), and postoperative tumor volume (HR = 1.010; 95% CI, 1.001 to 1.019; P = .03), progression-free survival was predicted by log preoperative tumor volume (HR = 2.711; 95% CI, 1.590 to 4.623; P <or= .001) and postoperative tumor volume (HR = 1.007; 95% CI, 1.001 to 1.014; P = .035), and malignant progression-free survival was predicted by EOR (HR = 0.983; 95% CI, 0.972 to 0.995; P = .005) and log preoperative tumor volume (HR = 3.826; 95% CI, 1.632 to 8.969; P = .002).
Improved outcome among adult patients with hemispheric LGG is predicted by greater EOR.

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    • "Although recent advances have been made in chemotherapy and radiation therapy for LGGs, surgical resection remains essential to its management. A growing body of literature supports the claim that a greater extent of resection leads to a significant survival benefit for LGGs59606162636465. The National Comprehensive Cancer Network (NCCN) guidelines for the management of low-grade infiltrative supratentorial astrocytoma/oligodendroglioma in adult patients recommend maximum safe resection of tumor tissue, if possible, with the caveat that serial observation may be appropriate for selected patients [66]. "
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    • "Mounting evidence suggests that the extent of neurosurgical resection of low-and high-grade gliomas correlates positively with patient prognosis: including incidence of recurrence123, overall survival456789101112 , and progression-free survival4569,10,13]. Interestingly, a much higher rate of gross total resection, as assessed by postoperative MRI, (mean rate of 62.3%1415161718) has been reported in patients with high-grade gliomas (HGGs) compared to low-grade gliomas (LGGs) (mean rate of 27.3% [19]). "
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