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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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Prognostic factors concerning progression-free and overall survival in primary glioblastoma – follow up results of a randomized trial

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  • Florian Geßler - Universitätsklinikum Frankfurt, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Peter Baumgarten - Universitätsklinikum Frankfurt, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Patrick Harter - Universitätsklinikum Frankfurt, Neurologisches Institut, Frankfurt am Main, Deutschland
  • Andrea Bink - Universitätsklinikum Frankfurt, Institut für Neuroradiologie, Frankfurt am Main, Deutschland
  • Volker Seifert - Universitätsklinikum Frankfurt, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Christian Senft - Universitätsklinikum Frankfurt, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocV275

doi: 10.3205/18dgnc293, urn:nbn:de:0183-18dgnc2938

Published: June 18, 2018

© 2018 Geßler 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

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Objective: In a randomized controlled trial (RCT) the use of an intraoperative MRI (iMRI) led to improved rates of complete tumor removal. Further, tumor removal was associated with longer progression-free survival. However, overall survival (OS) was not addressed in the primary analysis.

Methods: In a prospective, randomized, parallel-group trial, we enrolled adults (≥18 years) with contrast enhancing gliomas amenable to radiologically complete resection who presented to our institution. We randomly assigned patients (1:1) to undergo intraoperative MRI-guided surgery or conventional microsurgery (control group). Analysis was done per protocol. At 5-year follow-up, we performed an analysis of survival data of patients who participated in this trial. This study is registered withClinicalTrials.gov, number NCT01394692.

Results: We analyzed 58 patients enrolled between Oct 1, 2007, and July 1, 2010. 24 (83%) of 29 patients randomly allocated to the intraoperative MRI group and 25 (86%) of 29 controls were eligible for analysis. Overall median OS was 19.2 months. The use of iMRI itself did not affect outcome (560 vs. 624 days, p=0.83). GTR (641 vs. 437 days, p=0.043),MGMTpromotor methylation status (641 vs. 500 days, p=0.028) and tumor recurrence (825 vs. 560 days, p=0.042) were associated with overall survival in a multivariate analysis. In treated for a newly diagnosed primary,MGMTpromotor methylation status (724 vs. 465 days, p=0.028) and GTR (567 vs. 402 days, p=0.045) were identified as prognosticators affecting overall survival.

Conclusion: Our secondary endpoint analysis from an RCT provides evidence that complete resection is an independent prognostic factor in high grade glioma. Use of iMRI helps to achieve a greater extent of resection and thus directly impacts patient outcome.