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Does Extent of Resection Impact Survival in Patients Bearing Glioblastoma?

Published online by Cambridge University Press:  02 December 2014

Nicolas Dea ,
Marie-Pierre Fournier-Gosselin ,
David Mathieu ,
Philippe Goffaux  and
David Fortin
Nicolas Dea
Affiliation:
Division of Neurosurgery and Neuro-oncology, Surgery Department, Université de Sherbrooke, Sherbrooke
Marie-Pierre Fournier-Gosselin
Affiliation:
Division of Neurosurgery, Surgery Department, Université de Montréal, Montréal, Quebec, Canada
David Mathieu
Affiliation:
Division of Neurosurgery and Neuro-oncology, Surgery Department, Université de Sherbrooke, Sherbrooke
Philippe Goffaux
Affiliation:
Division of Neurosurgery and Neuro-oncology, Surgery Department, Université de Sherbrooke, Sherbrooke
David Fortin*
Affiliation:
Division of Neurosurgery and Neuro-oncology, Surgery Department, Université de Sherbrooke, Sherbrooke
*
Université de Sherbrooke, Division of Neurosurgery and Neuro-oncology, 3001, 12th Avenue North, Sherbrooke, Quebec, J1H 5N4, Canada. Email: [email protected]
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Abstract

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Background:

The impact of malignant glioma resection on survival is still a matter of controversy. The lack of well-designed prospective studies as well as control of all factors in retrospective studies plays an important role in this debate. Amongst some of these uncontrolled factors, are the inclusion of different histological grades, the lack of objective methods to estimate the extent of resection and unspecified delays in post-operative imaging.

Methods:

We retrospectively reviewed 126 consecutive patients with glioblastoma, operated on by the senior authors at the Centre Hospitalier Universitaire de Sherbrooke, who met the following criteria: >18 years of age, newly diagnosed glioblastoma, pre-operative magnetic resonance imaging (MRI) within 2 weeks prior to surgery, and a post-operative MRI within 72 hours after surgery. Extent of tumour resection was calculated using pre and post-operative tumour delimitation on gadolinium-enhanced T1 MRI in a volumetric analysis.

Results:

Applying stringent specific inclusion criteria, 126 patients were retained in the analysis. The median overall survival was 271 days and the median extent of resection was 65%. Patients with more than 90% of tumour resection had a significantly better outcome, improving median survival from 225 to 519 days (P=0.006). Other factors that significantly improved survival were the use of radiotherapy, the number of regimens and type of chemotherapy used.

Conclusion:

A more aggressive approach combining maximal safe resection and use of salvage chemotherapy seems to confer a survival advantage for glioblastoma patients.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 5 , September 2012 , pp. 632 - 637
Copyright
Copyright © The Canadian Journal of Neurological 2012

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