Artikel
Clinical outcome of patients with subtotally resected unilocular glioblastomas involving eloquent areas utilizing intraoperative MRI – a multi-center retrospective comparative analysis
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Autoren
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Javier Segovia von Riehm
- Klinik für Neurochirurgie, Klinikum Stuttgart, Stuttgart, Deutschland
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Annika Gerber
- Klinik für Neurochirurgie, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Deutschland
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Mirjam Renovanz
- Universitätsmedizin Mainz, Neurochirurgische Klinik, Mainz, Deutschland
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Oliver Ganslandt
- Klinikum Stuttgart, Neurochirurgische Klinik, Stuttgart, Deutschland
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Christian Rainer Wirtz
- Universitätsklinikum Ulm, Klinik für Neurochirurgie, Ulm, Deutschland
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Jan Coburger
- Neurochirurgische Klinik der Universität Ulm, Standort Günzburg, Günzburg, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Aim of this multi-center-study is to evaluate extent of resection (EoR) in preoperatively intended subtotal resection (STR) of glioblastomas (GBs) involving eloquent areas depending on the use of intraoperative MRI (iMRI). Further, to assess clinical outcome and progression free (PFS) and overall survival (OS).
Methods: Patient data from 3 neurosurgical centers (years 2008-2013) was retrospectively reviewed including patients with primary GB (pGB) – or their recurrence (rGB). Tumors presenting unilocular growth, involving eloquent areas with intended STR were included. All patients underwent comparable adjuvant therapy. Imaging data was pseudonymized and assessed blinded by one central reviewer (neurosurgeon). Overall EoR (oEoR) was assessed based on pre-and postoperative tumor volume with iPlan 3.0 (Brainlab). In addition, a potentially resectable tumor volume (RV) was defined by the reviewer. Based on this data, a delta EOR (dEoR) achieved during the respective surgery was calculated. We calculated multivariate linear regression for oEoR and dEoR, binary regression for complications and Cox-regression for PFS and OS.
Results: Out of 101 patients, 88 presented pGBs and 13 presented rGBs. 46 patients underwent surgery without (w/o) iMRI, 38 patients with (w/) iMRI. In linear regression model controlling for age, tumor volume, neurophysiological mapping and use of iMRI no significant impact on any variable on oEoR was found. Yet, using the same model but assessing achieved dEoR, we solely found a significant influence of iMRI minimizing residual tumor (p=0.03). In binary regression model controlling for age, tumor volume, EoR, neurophysiological mapping and use of iMRI, none of the variables showed a significant difference concerning complications. OS was significantly higher (p=0.01) w/ iMRI (median OS = 10 months) compared to surgery w/o iMRI (median OS = 9 months). Minimal EoR>70% and maximum RV<5 cm3 independently showed a significant advantage (p<0.01, p=0.01) concerning OS. Both criteria were found simultaneously in 48% of patients treated w/ iMRI and 24% of patients treated w/o iMRI (p=0.04).
Conclusion: Pointing out the importance of maximum safe resection in STR in order to achieve survival benefit, our data shows significant superiority in the use of iMRi.
