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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    • "We hope this will make image interpretation easier at the end of a brain tumor resection, an improvement that could be of particular importance for users with limited experience in using ultrasound guided surgery. Improved imaging near the end of the surgery could be associated with improved resection grades that again improves clinical outcome [2,4,5,16]. We now hope to translate these positive findings from simulation and the animal models to highly selected patients with suspected high-grade glioma to further evaluate the potential benefits while carefully monitor any potential adverse events. "
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    ABSTRACT: Use of ultrasound in brain tumor surgery is common. The difference in attenuation between brain and isotonic saline may cause artifacts that degrade the ultrasound images, potentially affecting resection grades and safety. Our research group has developed an acoustic coupling fluid that attenuates ultrasound energy like the normal brain. We aimed to test in animals if the newly developed acoustic coupling fluid may have harmful effects. Eight rats were included for intraparenchymal injection into the brain, and if no adverse reactions were detected, 6 pigs were to be included with injection of the coupling fluid into the subarachnoid space. Animal behavior, EEG registrations, histopathology and immunohistochemistry were used in assessment. In total, 14 animals were included, 8 rats and 6 pigs. We did not detect any clinical adverse effects, seizure activity on EEG or histopathological signs of tissue damage. The novel acoustic coupling fluid intended for brain tumor surgery appears safe in rats and pigs under the tested circumstances.
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    • "A significant survival benefit 58 was demonstrated if treated at a centre favoring early surgical 59 resection as opposed to biopsy and watchful waiting. Most authors 60 now argue in favor of early resections [2] [3] [4] [5]. However, the balanc- 61 ing act between improving survival by extensive resections and 62 inducing deficits is delicate. "
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    Full-text · Article · Feb 2014 · Journal of Clinical Neuroscience
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    • "Resection was extended up to functional boundaries assessed by stimulation mapping that respected both eloquent cortical areas and essential subcortical pathways. This approach limits neurologic deficits while maximizing the extent of resection which is thought to have a positive impact on the further course of LGG [Smith et al., 2008; Soffietti et al., 2010]. The neurologic status was assessed immediately after surgery and again after 3 months analogical to the preoperative assessment. "
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