Abstract
The oncological and functional outcomes in glioblastoma (GBM) patients following supratotal resection (SupTR), involving complete resection of contrast-enhancing enhanced (CE) tumors and areas of methionine (Met) uptake on 11C-met positron emission tomography (Met-PET), are unknown. We conducted a retrospective review in newly diagnosed, IDH1 wild-type GBM patients, comparing SupTR with gross total resection (GTR), in which only CE tumor tissue was resected. All patients underwent standard radiotherapy and temozolomide treatment, and were followed for tumor recurrence and overall survival (OS). Among the 30 patients included in this study, 7 underwent SupTR and 23 underwent GTR. Awake craniotomy with cortical and subcortical mapping was more frequently performed in the SupTR group than in the GTR group. During the follow-up period, significantly different patterns of disease progression were observed between groups. Although more than 80% of recurrences were local in the GTR group, all recurrences in the SupTR group were distant. Median OS in the GTR and SupTR groups was 18.5 months (95% confidence interval [CI] 14.2–35.1) and not reached (95% CI 30.5-not estimable), respectively; this difference was statistically significant (p = 0.03 by log-rank test). No postoperative neurocognitive decline was evident in patients who underwent SupTR. Compared to GTR alone, aggressive resection of both CE tumors and areas with Met uptake (SupTR) under awake craniotomy with functional mapping results in a survival benefit associated with better local control and neurocognitive preservation.
Highlights
The oncological and functional outcomes in glioblastoma (GBM) patients following supratotal resection (SupTR), involving complete resection of contrast-enhancing enhanced (CE) tumors and areas of methionine (Met) uptake on 11C-met positron emission tomography (Met-PET), are unknown
Is there a subpopulation of GBM patients who are amenable to extensive resection? Second, is neuropsychological performance after SupTR truly feasible and acceptable? detailed pre- and postoperative cognitive data are lacking in a majority of previous reports
After comparing the resection cavity of CE lesions and areas of Met uptake, 7 patients were categorized into the SupTR group and the remaining 23 into the gross total resection (GTR) group (Fig. 1)
Summary
The oncological and functional outcomes in glioblastoma (GBM) patients following supratotal resection (SupTR), involving complete resection of contrast-enhancing enhanced (CE) tumors and areas of methionine (Met) uptake on 11C-met positron emission tomography (Met-PET), are unknown. L i11 and P essina[12] presented their SupTR concept, in which the surrounding abnormal FLAIR region is resected if feasible and safe, reporting median OS of 20.7 months and 28.6 months, respectively This extensive resection strategy and survival benefit were supported by the results of a retrospective multicenter cohort study[13] that demonstrated a positive association between maximal resection of noncontrast tumors and OS in select GBM patients. Isocitrate dehydrogenase (IDH) gene status must be included in patient selection criteria, as IDH1mutated GBM has a unique natural history In this retrospective, single-center study, we aimed to clarify the possible survival benefit of additional resection of tissue demonstrating Met uptake beyond the contrast-enhanced region of tumors in patients with newly diagnosed, IDH1 wild-type GBM, and to evaluate neuropsychological outcomes following SupTR
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