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 . "
[Show abstract][Hide abstract]ABSTRACT: The Chinese Glioma Cooperative Group (CGCG) Guideline Panel for adult diffuse gliomas provided recommendations for diagnostic and therapeutic procedures. The Panel covered all fields of expertise in neurooncology, i.e. neurosurgeons, neurologists, neuropathologists, neuroradiologists, radiation and medical oncologists and clinical trial experts. The task made clearer and more transparent choices about outcomes considered most relevant through searching the references considered most relevant and evaluating their value. The scientific evidence of papers collected from the literature was evaluated and graded based on the Oxford Centre for Evidence-based Medicine Levels of Evidence and recommendations were given accordingly. The recommendations will provide a framework and assurance for the strategy of diagnostic and therapeutic measures to reduce complications from unnecessary treatment and cost. The guideline should serve as an application for all professionals involved in the management of patients with adult diffuse glioma and also as a source of knowledge for insurance companies and other institutions involved in the cost regulation of cancer care in China.
"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% ). "
"As these patients were treated in the routine clinic, some patients had insufficient imaging to permit some types of analysis. Quantification of the extent of resection, ideally by volumetric techniques, as employed by previous studies, all of which reported its prognostic value [14, 20, 35], could not be performed in our series. Similarly not all patients had multimodal imaging (e.g. "