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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Complete resection as the only option? Impact of the molecular tumor pattern following subtotal resection

Meeting Abstract

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  • Julia Ehrmann - Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Hans-Jakob Steiger - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Michael C. Sabel - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Marcel Alexander Kamp - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Duesseldorf, Deutschland
  • Marion Rapp - Neurochirurgie Uniklinik Düsseldorf, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 071

doi: 10.3205/17dgnc634, urn:nbn:de:0183-17dgnc6343

Published: June 9, 2017

© 2017 Ehrmann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: The survival benefit of a complete resection of the contrast-enhancing malignant glioma tissue has clearly been demonstrated. Recently, molecular pattern, mainly MGMT promotor methylation and IDH1 mutation gained more importance within the decision-making process of the therapy. As prognostic markers, in patients with a favorable molecular constellation overall survival is improved. However, it is not known, whether a favorable molecular constellation can compensate the disadvantage of subtotal resection. Therefore, here we analyzed the progress of residual tumor tissue depending from the molecular tumor status.

Methods: In this retrospective analysis we included (1) primary glioblastoma patients (2) with postoperative residual tumor tissue (3) who were treated according to STUPP scheme (4) at our neurooncological department. Molecular data were correlated with clinical data and survival.

Results: Between 2010 and 2015, 177 primary glioblastoma patients were treated in our department. In 78 patients (median age 60 years, f= 31, m=47, eloquent tumor location n=65), residual tumor was described in the early postoperative MRI control. MGMT promotor methylation was positive in 30, negative in 36 and unknown in 12 patients. The vast majority was IDH1-negative (98.7%). Median overall survival (OS) as well as progression free survival (PFS) was significantly increased in patients with positive MGMT promotor methylation (14 months for MGMT-methylated patients vs. 10 months for MGMT neg; p =0.06; PFS: 10.8 months vs. 6.8 months; p =0.05) Next to MGMT status, residual tumor size as well as tumor location was identified as being prognostic relevant: Patients with residual tumor volume < 1,5 cm3 (median OS 13 months; median PFS: 8 months; p =0.4) and patients with a tumor location within the temporal lobe (median OS 14 months; median PFS: 11 months; p =0.5) had a favorable outcome.

Conclusion: Our data confirm the impact of MGMT promotor methylation, residual tumor size as well as tumor localization on survival. Although there might be a benefit, the adjuvant therapy cannot control the residual tumor and the total resection should remain the gold standard.