Article
Integrative analysis of surgical, neurological and oncological outcomes of corpus callosum glioblastoma multiforme
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Authors
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Pamela Franco Jimenez
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany, Freiburg, Deutschland
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Dieter Henrik Heiland
- Department of Neurosurgery, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Deutschland
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Peter Reinacher
- Universitätsklinikum Freiburg, Abt. Stereotaktische und Funktionelle Neurochirurgie, Freiburg, Deutschland
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Waseem Masalha
- Uniklinik Freiburg, Freiburg, Deutschland
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Bianca Mercas
- Freiburg, Deutschland
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Oliver Schnell
- Department of Neurosurgery, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Glioblastomas are the most aggressive tumors of the central nervous system. When they appear in the Corpus callosum, the typical growth pattern extends to both cerebral hemispheres, most commonly within the frontal lobe, but an invasion of the both parietal and both occipital lobes can also be found. The involvement of the Corpus callosum usually leads to poor clinical course and a gives the patient a dismal prognosis. Until now, the surgical benefit of this subgroup of glioblastomas is still unknown and there is no consensus about the optimal therapy strategy for these patients. The purpose of this study was to analyze the overall- and progression-free survival of corpus callosum glioma (CCG) and evaluate the functional outcome of patients who underwent biopsy compared to those who received surgical resection.
Methods: In this retrospective study, 58 patients were treated at the Department of Neurosurgery, Medical Center - University of Freiburg between 2009 and 2015. Indication for either stereotactic biopsy or surgical resection was based on individual patient characteristics. Time depended variables were analyzed by Cox-regression model. Primary endpoints were overall survival (OS) and progression-free survival (PFS). Secondary endpoints were NANO score, Karnofsky Performance Scale (KPS) and clinical parameters. Binomical variables were analyzed by univariate and multivariate regression models and chi-square test. The alpha-level was determined at 5% to achieve a statistical power of 0.8.
Results: Out of 58 patients 29 were biopsied and 29 underwent surgical resection (8 gross-total resection (GTR), 21 partial resection (PR)). Age and sex were balanced in both groups. Between the biopsy and partial resection groups, no significant differences were found (HR 1.02, PR mean OS 137 days, Biopsy OS 105 days p>0.05). Patients who underwent a GTR showed a significant improvement in overall and progression-free survival (OS 600 days, p<0.01). In all three groups, no significant differences between postoperative neurological outcome were found (PR NANO 2.38, NANO Biopsy 1.63, NANO GTR 1.88).
Conclusion: Patients with CCG may have significantly improved OS if GTR can be achieved with a moderate risk of an additional postoperative deficit. Surgical treatment, which failed a gross-total resection, does not improve the outcome of CCG and can even produce more neurological deficits. Therefore, in the individual treatment decision, if gross total resection is feasible, it should be the first treatment option. If this is not possible, biopsy and rapid adjuvant therapy should be recommended.
