Abstract
The purpose of this study is to clarify whether gross total tumor resection can prolong the survival in adult patients with supratentorial glioblastoma multiforme (GBM), and to clarify what subset of these patients obtains a survival advantage by gross total tumor resection without postoperative neurological deterioration.
Eighty-two adult patients with supratentorial GBM were retrospectively reviewed. Overall, the median survival time was 13 months, and the 1- and 2-year survival rates were 53.7% and 14.6%, respectively. In a univariate analysis for survival rate by log-rank test, age (>40 years), Karnofsky performance scale (KPS) score (70–100%) and extent of surgery (gross total resection) were revealed to be significant good prognostic factors. A Cox proportional hazard multivariate regression analysis confirmed that the KPS and extent of surgery were independent, significant good prognostic factors. Nine patients (11%) suffered postoperative neurological deterioration.
A topographical GBM staging system (Stages I, II and III) with the integration of tumor location, size and eloquence of adjacent brain based on MRI (for explanation of Stages see text) was originally proposed. In Stage I, gross total resection had a strong tendency toward a better prognostic factor in a univariate analysis and was revealed to be a significant independent good prognostic factor in a multivariate analysis. In also Stage II, the survival of patients who underwent gross total resection was better than that of patients with less than gross total resection, although not significant. In Stage III, there were no patients who underwent gross total tumor resection. Risk probabilities of postoperative neurological deterioration, overall, were 0%, 22.2%, and 20% in Stages I, II, and III, respectively, and those after gross total resection were 0% and 16.7% in Stages I and II, respectively.
Although gross total tumor resection is associated with prolongation of the survival time of patients with GBM, the risk of postoperative neurological deficit increases with radical tumor resection. To select an eligible subset of patients that benefit in survival from gross total tumor resection without postoperative risk, the following surgical policy for GBM resection is suggested. GBM in Stage I should be resected as radically as possible. Regarding Stage II, risky surgical resection extending to the area adjacent to the critical zone should be avoided and more meticulous and careful surgical planning is needed than that in Stage I. In Stage III, radical gross total tumor resection is not recommended at present.
Similar content being viewed by others
References
Sawaya R, Hammoud M, Schoppa D, Hess KR, Wu SZ, Shi WM, Wildrick DM: Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42: 1044–1056, 1998
Wigner MJ, MacDonald DR, Cairncross JG: Supratentorial anaplastic gliomas in adults: the prognostic importance of extent of resection and prior low-grade glioma. J Neurosurg 71: 487–493, 1989
Devaux BC, O'Fallon JR, Kelly PJ: Resection, biopsy, and survival in malignant glial neoplasm. A retrospective study of clinical parameters, therapy, and outcome. J Neurosurg 78: 765–775, 1993
Simpson JR, Horton J, Scott C, Curran WJ, Rubin P, Fishbach J, Isaacson S, Rotman M, Asbell SO, Nelson JS, Weinstein AS, nelson DF: Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: Results of three consecutive radiation therapy oncology group (RTOG) clinical trials. Int J Radiat Oncol Biol Phys 26: 239–244, 1993
Jeremic B, Grujicic D, Antunovic V, Djuric L, Stojanovic M, Shibamoto Y: Influence of extent of surgery and tumor location on treatment outcome of patients with glioblastoma multiforme treated with combined modality approach. J Neuro-Oncol 21: 177–185, 1994
Jeremic B, Grujicic D, Antunovic V, Djuric L, Shibamoto Y: Accelerated hyperfractionated radiation therapy for malignant glioma. A phase II study. AmJ Clin Oncol 18: 449–453, 1995
Sneed PK, Prados MD, McDermott MW, Larson DA, Malec MK, Lamborn KR, Davis RL, Weaver KA, Wara WM, Phillips TL, Gutin PH: Large effect of age on survival of patients with glioblastoma treated with radiotherapy and brachytherapy boost. Neurosurgery 36: 898–903, 1995
Wurschmidt F, Bunemann H, Heilmann HP: Prognostic factors in high-grade malignant glioma. A multivariate analysis of 76 cases with postoperative radiotherapy. Strahlenther Onkol 171: 315–321, 1995
Levin VA, Maor MH, Thall PF, Yung WK, Bruner J, Sawaya R, Kyritsis AP, Leeds N, Woo S, Rodriguez L, Gleason MJ: Phase II study of accelerated fractionation radiation therapy with carboplatin followed by vincristine chemotherapy for the treatment of glioblastoma multiforme. Int J Radiat Oncol Biol Phys 33: 357–364, 1995
Barker II FG, Prados MD, Chang SM, Gutin PH, Lamborn KR, Larson DA, Malec MK, McDermott MW, Sneed PK, Wara WM, Wilson CB: Radiation response and survival time in patients with glioblastoma multiforme. J Neurosurg 84: 442–448, 1996
Buatti JM, Marcus RB, Mendenhall WM, Friedman WA, Bova FJ: Accelerated hyperfractionated radiotherapy for malignant gliomas. Int J Radiat Oncol Biol Phys 34: 785–792, 1996
Davies E, Clark C, Hopkins A: Malignant cerebral glioma - I: Survival, disability, and morbidity after radiotherapy. BMJ 313: 1507–1512, 1996
Gundersen S, Lote K, Hannisdal E: Prognostic factors for glioblastoma multiforme development of a prognostic index. Acta Oncol 35 (Suppl 8): 123–127, 1996
Salminen E, Nuutinen JM, Huhtala S: Multivariate analysis of prognostic factors in 106 patients with malignant glioma. Eur J Cancer 32A: 1918–1923, 1996
Durmaz R, Erken S, Arslantas A, Atasoy MA, Bal C, Tel E: Management of glioblastoma multiforme: with special reference to recurrence. Clin Neurol Neurosurg 99: 117–123, 1997
Kowalczuk A, MacDonald RL, Amidei C, Dohrmann G, Erickson RK, Hekmatpanah J, Krauss S, Krishnasamy S, Masters G, Mullan SF, Mundt AJ, Sweeney P, Vokes EE, Weir BK, Wollman RL: Quantitative imaging study of extent of surgical resection and prognosis of malignant astrocytomas. Neurosurgery 41: 1028–1036, 1997
Parados MD, Larson DA, Lamborn K, McDermott MW, Sneed PK, Wara WM, Chang SM, Mack EE, Krouwer HG, Chandler KL, Warnick RE, Davis RL, Rabbitt JE, Malec M, Levin VA, Gutin PH, Phillips TL, Wilson CB: Radiation therapy and hydroxyurea followed by the combination of 6-thioguanine and BCNU for the treatment of primary malignant brain tumors. Int J Radiat Oncol Biol Phys 40: 57–63, 1998
Hess KR: Extent of resection as a prognostic variable in the treatment of gliomas. J Neuro-Oncol 42: 227–231, 1999
Kleihues P, Burger PC, Scheithauer BW: Histological Typing of Tumours of the Central Nervous System. 2nd edn., Berlin, Springer-Verlag, 1993, pp 13–14
Sakai N, Yamada H, Andoh T, Hirata T, Nishimura Y, Miwa Y, Shimizu K, Yanagawa S: Intraoperative radiation therapy for malignant glioma. Neurol Med Chir (Tokyo) 31: 702–707, 1991
Takakura K, Abe H, Tanaka R, Kitamura K, Miwa T, Takeuchi K, Yamamoto S, Kageyama N, Handa H, Mogami H, Nishimoto A, Uozumi T, Matsutani M, Nonura K: Effects of ACNU and radiotherapy on malignant glioma. J Neurosurg 64: 53–57, 1986
Shinoda J, Sakai N, Hara A, Ueda T, Sakai H, Nakatani K: Clinical trial of external beam-radiotherapy combined with daily administration of low-dose cisplatin for supratentorial glioblastoma multiforme - a pilot study. J Neuro-Oncol 35: 73–80, 1997
Kaplan EC, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53: 447–454, 1958
Cox DR: Regression models and life tables (with discussion). J R Stat Soc (B) 32: 187–220, 1972
Nomura K, Yamaguchi N, Watanabe S: The statistical analysis of prognostic factors for brain tumors. In: Nagai M (ed) Brain Tumor Research and Therapy, Tokyo, Springer-Verlag, 1996, pp 29–38
The Committee on Cancer: American Joint Committee on Cancer TNM/UICC brain tumor. In Kaye AH, Laws ER Jr (eds) Brain Tumors. An Encyclopedic Approach. New York: Churchill Livingstone, 1995, 949–955
The Medical Research Council Brain Tumour Working Party: Prognostic factors for high-grade malignant glioma: development of a prognostic index. A report of the Medical Research Council Brain Tumour Working Party. J Neuro-Oncol 9: 47–55, 1990
Salcman M: Epidemiology and factors affecting survival. In: Apuzzo MLJ (ed) Malignant Cerebral Glioma. American Association of Neurological Surgeons, Park Ridge, 1990, pp ss 95–109
Latif AZ, Signorini D, Gregor A, Grant R, Ironside JW, Whittle IR: Application of the MRC brain tumour prognostic index to patients with malignant glioma not managed in randomised control trial. J Neurol Neurosurg Psychiatry 64: 747–750, 1998
Ammirati M, Vick N, Liao Y, Ciric I, Mikhael M: Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. Neurosurgery 21: 201–206, 1987
Kreth FW, Warnke PC, Scheremet R, Ostertag CB: Surgical resection and radiation therapy in the treatment of glioblastoma multiforme. J Neurosurg 78: 762–766, 1993
Kelly PJ, Hunt C: The limited value of cytoreductive surgery in elderly patients with malignant gliomas. Neurosurgery 34: 62–66, 1994
Vecht CJ, Avezaat CJ, van Putten WL, Eijkenboom WM, Stefanko SZ: The influence of the extent of surgery on the neurological function and survival in malignant glioma. A retrospective analysis in 243 patients. J Neurol Neurosurg Psychiatry 53: 466–471, 1990
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Shinoda, J., Sakai, N., Murase, S. et al. Selection of Eligible Patients with Supratentorial Glioblastoma Multiforme for Gross Total Resection. J Neurooncol 52, 161–171 (2001). https://doi.org/10.1023/A:1010624504311
Issue Date:
DOI: https://doi.org/10.1023/A:1010624504311