Article
Resection of predominantly FLAIR-Hyperintense intracranial gliomas with minor contrast-enhancement – evaluation of tumour entities, extent of resection and outcome in a consecutive single-centre cohort
Resektion von überwiegend FLAIR-Hyperintensen intrakraniellen Gliomen mit geringgradiger Kontrastmittelaffinität – Evaluation von Tumorentitäten, Resektionsausmaß und Outcome in einer konsekutiven Singe-Center Kohorte
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Published: | May 25, 2022 |
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Objective: Nowadays, the extent of resection (EOR) is an established prognosticator in treatment of intracranial gliomas and greater EOR has repeatedly been shown to correlate with improved survival. The aim of this study was to evaluate the role of EOR on survival in subgroups classified by MRI-characteristics and we sought to take a closer look at resection of different tumor portions and their respective impact on survival.
Methods: We screened a consecutive retrospective series of intracranial gliomas (n=529) from 1/2011 to 12/2018 for primary resections performed under intraoperative (i)MRI guidance that exhibited predominantly FLAIR hyperintense (nCE) tumor portions in combination with minor contrast enhancing (CE) tumor (max. 50% of total tumor volume). EOR was assessed semi-quantitatively on T1w and FLAIR pre- and postoperatively. Outcome was evaluated including clinical parameters and molecular histopathology. Progression-free survival was evaluated by Kaplan-Maier estimates.
Results: The final cohort (n=170) consisted of 101 male and 69 female patients with a median age of 52 years (range 21-86). Integrated histology showed 35 anaplastic astrocytomas, 22 anaplastic oligodendromas and 113 glioblastomas. Complete resection (CR) of both tumor portions (CE+nCE) was achieved in 101 patients (59%). 57 patients (34%) underwent CR of CE portions with partial resection (PR) of the nCE portions. 12 patients (7%) underwent PR with residual CE and nCE tumor. Postoperatively, 32 patients (16%) showed an initial neurological deterioration (24 patients with speech disorder and 8 with motoric deficit). 6 patients (3%) had mild residual und 4 patients (2%) severe persistent neurologic deficits. Overall Karnofsky-Performance-Index was unchanged pre- vs. postoperatively (90% (range 40-100 %) vs. 90% (range:20-100%), p=0.52. Kaplan-Maier estimates suggested an increased PFS associated with removal of CE or nCE portions of tumor. PFS was 53.1m for CR of CE and nCE tumor, 43m for CR of CE and PR of nCE tumor and 22m for PR with residual CE and nCE tumor, respectively. However, these estimates failed to reach statistical significance. Median follow-up was 52 (2-114) months.
Conclusion: Our results suggest an impact on PFS associated with the removal of different tumor portions ingliomas exhibiting nCE with minor CE aspects. Volumetric quantification of tumor compartments is underway to further evaluate the interplay between EOR for each compartment and histology and their respective impact on outcome.