Artikel
Resection of WHO grade III gliomas with minor contrast-enhancement – evaluation of tumour entities, extent of resection and outcome in a consecutive single-centre cohort
Resektion von WHO Grad III Gliomen mit geringgradiger Kontrastmittelaffinität – Evaluation von Tumorentitäten, Resektionsausmaß und Outcome in einer konsekutiven Single-Center Kohorte
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Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: The impact of the extent of resection (EOR) in glioma treatment has been a focus of attention and EOR has repeatedly been shown to correlate with improved survival. However, in gliomas exhibiting contrast enhancing (CE) and non-enhancing (nCE) tumor portions, the role of EOR is less clear. In these cases, we sought to take a closer look at removing different tumor portions and their impact on survival.
Methods: We screened a consecutive retrospective series of WHO Grade III Gliomas (n=178) from 01/2011 to 12/2018 for primary resections that exhibited FLAIR hyperintense nCE tumor portions in combination with minor CE tumor (max. 50% of total tumor volume). Tumor volume was assessed on T1w and FLAIR pre- and postoperatively. Outcome was evaluated including molecular histopathology and EOR. Progression-free survival (PFS) was evaluated by Kaplan-Maier estimates.
Results: This cohort consisted of 27 male and 29 female patients with a median age of 42 years (range 18-80). Integrated histology revealed 34 anaplastic astrocytomas, 21 anaplastic oligodendromas and 1 anaplastic ependymoma. IDH mutations were found in 51 cases (91%). Complete resection (CR) of both tumor portions (CE+nCE) was achieved in 37 patients (66%). 14 patients (25%) underwent CR of CE portions with partial resection (PR) of the nCE portions. 5 patients (9%) underwent PR with residual CE and nCE tumor. Postoperatively, 9 patients (16 %) had transient neurological deterioration (4 patients with speech disorder and 5 with motor deficits). 3 patients (5%) had new persistent neurologic deficits. Overall Karnofsky-Performance-Index was unchanged pre- vs. postoperatively (90 % (range 80-100 %) vs. 90% (range: 20-100%), p=0.42). Kaplan-Maier estimates suggested an increased PFS associated with removal of either CE or nCE portions of tumor. PFS was 48.5m for CR of CE and nCE tumor, 41m for CR of CE and PR of nCE tumor and 23m for PR with residual CE and nCE tumor, respectively. However, these estimates failed to reach statistical significance. Median follow-up was 47 (2-114) months.
Conclusion: Our results suggest an impact on PFS associated with the removal of different tumor portions in WHO grade III gliomas exhibiting nCE with minor CE aspects. An extension of our analysis also including lower and high-grade gliomas exhibiting comparable imaging characteristics is underway to further evaluate the impact of resecting different tumor portions also in conjunction with molecular aspects of histology and survival.