SURG-29. PERSONALIZING THE DECISION GROSS TOTAL RESECTION (GTR) IN NEURO-ONCOLOGY

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Since glial tumors are inherently infiltrative, microscopic total resection is not possible without significant morbidity. The efficacy of cyto-reduction through gross total resection (GTR) largely depends on the chemo-sensitivity of the remaining tumor. For instance, GTR of primary CNS lymphoma (PCNSL) is rarely desired. Since chemo-sensitivity differ depending on glioma histology, we hypothesized that the survival benefit of GTR differ accordingly. We identified patients who underwent surgery for WHO grade II diffuse astrocytoma (DA, n= 4,113), WHO grade III anaplastic astrocytoma (AA, n=2,755), glioblastoma (n=21,962), and oligodendroglioma (grade II n=2,378; grade III n=11,028) in the Surveillance, Epidemiology, and End Results Program (SEER, 1999-2012). Median survival and hazard ratio (HR) for dying from the disease after correction of pertinent clinical/demographic variables was determined as a function of GTR, and subtotal resection (STR). Pertinent results were assessed against published literature. Based on hazard ratio analysis, DA and AA patients derived the greatest survival benefit from GTR. The median survival for patients with DA who underwent GTR and STR were >60 and 48 months, respectively. The median survival for patients with AA who underwent GTR and STR were 54 and 24 months, respectively. Glioblastoma patients derived modest survival benefit from GTR, with median survival of 13 months for GTR patients and 9 months for STR patients. In contrast, for grade II or III oligodendrogliomas, survival of GTR patients did not significantly differ irrespective of the extent of resection. Meta-analysis of articles identified from a comprehensive search of the published literature yield results comparable to the SEER database. Our study suggest that surgeons should take tumor histopathology into account when deciding upon the extent of surgical resection of glial tumors and the critical need for real-time intra-operative histologic diagnosis.