Impact of peri-tumoral resection on survival in primary glioblastoma.
Glioblastoma (GBM) is the most common primary brain malignancy, and standard treatment includes maximal resection of contrast-enhancing tumor. Given recent interest in resection beyond areas of contrast-enhancement, the authors analyzed the role of peri-tumoral resection (PTR) in primary GBM.
This study included 126 adult patients with primary GBM amenable to peri-tumoral resection (PTR) at a tertiary care academic medical center. Patient characteristics and pre/postoperative tumor volumes were collected. Outcome-oriented cut-points for extent of resection of contrast-enhancing tumor (EOR) were determined using maximally selected rank statistics. Multivariable Cox proportional hazards (CPH) model for death was performed.
This cohort had mean age 60.7 ± 11.3 years and median overall survival (OS)/progression-free survival (PFS) 15.2/7.5 months. EOR >92.1% was associated with increased OS compared to <92.1% EOR (23.1 vs.14.0 months, p < .01). Fifty-four (42%) patients received PTR, of which 28 (22%) achieved PTR of >1.74 cm3 beyond the contrast-enhancing region. This latter group demonstrated greater OS than the PTR<1.74 cm3 group (21.6 vs. 16.8 months, p < 0.01). There was no significant difference in postoperative complications between groups. Multivariable CPH model found EOR 92.1%-99% (hazard ratio [HR], 0.30; confidence interval [CI], 0.15-0.60, p < .01) and PTR >1.74 cm3 (HR, 0.27; CI, 0.13-0.56, p < .01) were associated with increased OS. Preoperative T2-FLAIR volume >192 cm3 was associated with worse OS (HR, 3.18; CI, 1.17-8.61, p < .01).
Our results demonstrate increased OS in GBM with resection beyond contrast-enhancing tumor margins. With no associated increase in postoperative deficits, PTR >1.74 cm3 was both effective and safe in select cases.
This study included 126 adult patients with primary GBM amenable to peri-tumoral resection (PTR) at a tertiary care academic medical center. Patient characteristics and pre/postoperative tumor volumes were collected. Outcome-oriented cut-points for extent of resection of contrast-enhancing tumor (EOR) were determined using maximally selected rank statistics. Multivariable Cox proportional hazards (CPH) model for death was performed.
This cohort had mean age 60.7 ± 11.3 years and median overall survival (OS)/progression-free survival (PFS) 15.2/7.5 months. EOR >92.1% was associated with increased OS compared to <92.1% EOR (23.1 vs.14.0 months, p < .01). Fifty-four (42%) patients received PTR, of which 28 (22%) achieved PTR of >1.74 cm3 beyond the contrast-enhancing region. This latter group demonstrated greater OS than the PTR<1.74 cm3 group (21.6 vs. 16.8 months, p < 0.01). There was no significant difference in postoperative complications between groups. Multivariable CPH model found EOR 92.1%-99% (hazard ratio [HR], 0.30; confidence interval [CI], 0.15-0.60, p < .01) and PTR >1.74 cm3 (HR, 0.27; CI, 0.13-0.56, p < .01) were associated with increased OS. Preoperative T2-FLAIR volume >192 cm3 was associated with worse OS (HR, 3.18; CI, 1.17-8.61, p < .01).
Our results demonstrate increased OS in GBM with resection beyond contrast-enhancing tumor margins. With no associated increase in postoperative deficits, PTR >1.74 cm3 was both effective and safe in select cases.
Authors
Tang Tang, Botros Botros, Kim Kim, Khalafallah Khalafallah, Dux Dux, Fox Fox, Hussain Hussain, Mao Mao, Pellegrino Pellegrino, Sharma Sharma, Lucas Lucas, Ahmed Ahmed, Jackson Jackson, Gallia Gallia, Bettegowda Bettegowda, Weingart Weingart, Brem Brem, Mukherjee Mukherjee
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