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Residual enhancing disease after surgery for glioblastoma multiforme: National service evaluation of practice in the United Kingdom
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Veröffentlicht: | 9. Juni 2017 |
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Objectives: Despite extensive clinical research the prognosis for patients with glioblastoma (GBM) remains poor. Surgical management of GBM patients has improved significantly with the introduction of new technologies and clinical sub-specialisation. A growing body of clinical data highlights the prognostic importance of post-operative residual enhancing disease (RED) following resection. Recent clinical trial data has started to emphasise the importance of gross total resection (GTR), defined by the absence of RED on early post-operative MRI, compared to sub-total resection (STR). Here we report the results of a service evaluation of practice in the United Kingdom.
Methods: Multicentre prospective observation study to evaluate current neuro-oncological practice in the United Kingdom. Data was collected between 01/05/2016 and 31/07/2016 through the British Neurosurgery Trainees Research Collaborative. Patients were included if they had suspected GBM and were scheduled to undergo GTR at their first surgery. Inclusion criteria included adult patients (age >18) with suspected GBM on presenting magnetic resonance imaging (MRI) scan and multi-disciplinary meeting (MDT) decision that the tumour was suitable for GTR. Exclusion criteria included children (age <18) with subsequent histology that confirmed an alternative diagnosis.
Results: A total of 113 patients from 15 neurosurgical units who were deemed suitable for gross total resection for treatment of glioblastoma were recruited. There was varying use of surgical adjuncts between differing neurosurgical units. Most patients (70.8%) had a postoperative MRI scan within 72hours of surgery. GTR was deemed to be achieved at time of surgery in 82% (91/111) of cases, compared to only 45% (36/80) on postoperative MRI. RED was deemed operable in 16.3% (13/80) of cases, however, no patient underwent early repeat surgery for RED. The most commonly cited reason (38.5%, 5/13) was perceived lack of clinical benefit.
Conclusion: Despite advances in surgical technique there is a subset of patients in which GTR is thought possible, but not achieved at primary surgery. Thus residual disease may be amenable to early reintervantion. Further prospective surgical research is required to better define the prognostic implications of RED/GTR and explore the options for converting STR to GTR before starting definitive treatment.