The influence of intraoperative resection control modalities on survival following gross total resection of glioblastoma.

Publication

The influence of intraoperative resection control modalities on survival following gross total resection of glioblastoma.

Journal Paper/Review - Feb 9, 2016

Neidert Marian C, Regli Luca, Woernle Christoph M, Eisele Günter, Kofmehl Reto, Held Ulrike, Mohme Malte, Burkhardt Jan-Karl, Hostettler Isabel, Bozinov Oliver

Citation

Neidert M, Regli L, Woernle C, Eisele G, Kofmehl R, Held U, Mohme M, Burkhardt J, Hostettler I, Bozinov O. The influence of intraoperative resection control modalities on survival following gross total resection of glioblastoma. Neurosurg Rev 2016; 39:401-9.

Type

Journal Paper/Review (English)

Journal

Neurosurg Rev 2016; 39

Publication Date

Feb 9, 2016

Issn Electronic

1437-2320

Pages

401-9

Brief description/objective

The purpose of the present study is to analyze the impact of intraoperative resection control modalities on overall survival (OS) and progression-free survival (PFS) following gross total resection (GTR) of glioblastoma. We analyzed data of 76 glioblastoma patients (30f, mean age 57.4 ± 11.6 years) operated at our institution between 2009 and 2012. Patients were only included if GTR was achieved as judged by early postoperative high-field MRI. Intraoperative technical resection control modalities comprised intraoperative ultrasound (ioUS, n = 48), intraoperative low-field MRI (ioMRI, n = 22), and a control group without either modality (n = 11). The primary endpoint of our study was OS, and the secondary endpoint was PFS-both analyzed in Kaplan-Meier plots and Cox proportional hazards models. Median OS in all 76 glioblastoma patients after GTR was 20.4 months (95 % confidence interval (CI) 18.5-29.0)-median OS in patients where GTR was achieved using ioUS was prolonged (21.9 months) compared to those without ioUS usage (18.8 months). A multiple Cox model adjusting for age, preop Karnofsky performance status, tumor volume, and the use of 5-aminolevulinic acid showed a beneficial effect of ioUS use, and the estimated hazard ratio was 0.63 (95 % CI 0.31-1.2, p = 0.18) in favor of ioUS, however not reaching statistical significance. A similar effect was found for PFS (hazard ratio 0.59, p = 0.072). GTR of glioblastoma performed with ioUS guidance was associated with prolonged OS and PFS. IoUS should be compared to other resection control devices in larger patient cohorts.