gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

07. - 11. Mai 2011, Hamburg

The influence of intraoperative high-field MRI on the extent of resection and patient survival in the surgical management of glioblastoma multiforme

Meeting Abstract

  • D. Kuhnt - Klinik für Neurochirurgie, Universitätsklinikum Marburg, Marburg
  • A. Becker - Klinik für Neurochirurgie, Universitätsklinikum Marburg, Marburg
  • O. Ganslandt - Klinik für Neurochirurgie, Universitätsklinikum Erlangen-Nürnberg, Erlangen
  • M. Buchfelder - Klinik für Neurochirurgie, Universitätsklinikum Erlangen-Nürnberg, Erlangen
  • M.H.A. Bauer - Klinik für Neurochirurgie, Universitätsklinikum Marburg, Marburg
  • C. Nimsky - Klinik für Neurochirurgie, Universitätsklinikum Marburg, Marburg

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.04.02

DOI: 10.3205/11dgnc010, URN: urn:nbn:de:0183-11dgnc0109

Veröffentlicht: 28. April 2011

© 2011 Kuhnt et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The extent of resection (EOR) in the management of glioblastoma multiforme (GBM)-therapy still remains controversial. However, an increasing amount of studies favour, that maximum EOR positively influences patient outcome. It was examined, whether the influence of intraoperative high-field magnetic resonance imaging (iMRI) and its effects on EOR (including a volumetric tumor analysis) are associated with longer patient survival.

Methods: 135 GBM patients underwent craniotomy and tumor resection with the aid of 1.5T iMRI and integrated multimodal navigation. In cases of remnant tumor, an update of navigation was performed with the intraoperative images. Tumor volume was quantified pre- and intraoperatively, by manual segmentation, outlining contrast enhancing areas. Univariate analysis was performed for the variables EOR, patient age, recurrent tumor, tumor localization and gender. Depending on the statistically significance of the univariate analysis, the multivariate model Cox proportional hazard was obtained.

Results: IMRI detected residual tumor volume in 88 patients, whereas in only 19 patients surgery was continued. Thus, the percentage of gross-total resection could be increased from 47 (34.8%) to 56 (41.49%) patients. Furthermore, absolute tumor volume was significantly reduced due to further tumor resection after iMRI. Univariate analysis using Kaplan Meier estimates showed that EOR and patient age are prognostic factors for survival time. The median survival was 14 months (95% confidence interval (CI): 11.7-16.2) for EOR ≥98%, 9 months (95% CI: 7.5–10.5) for EOR <98% (p<0.001). Considering this, out of the 19 patients with continued surgery after iMRI, the first iMRI showed an EOR ≥98% in 0 patients, after continued surgery due to this scan in 10 patients. A patient age ≥65 years was associated with a median survival of 9 months (95% CI: 7.3-10.7), <65 years with 12 months (95% CI: 8.4–15.6) (p=0.04). Cox proportional hazard model showed, that a patient age <65 years combined with an EOR ≥98% predicts longer survival (p=0.002).

Conclusions: Intraoperative high-field MRI significantly contributes to enlarged EOR and gross-total resections in GBM-surgery without higher postoperative morbidity. These extended resections of ≥98% EOR as well as a patient age < 65 years are associated with significantly improved patient survival. Gender, tumor localization and recurrent tumor do not have a statistical influence.