Relation between residual tumor volume after surgery and overall survival in patients with glioblastoma – a single neuro-oncology center study

Download PDF Czech version

Authors: M. Halaj ¹; O. Kalita ^1,2; M. Šlachta ¹; J. Valošek ¹; O. Burkot ³; P. Kouřilová ⁴; E. Čecháková ⁵; M. Doležel ⁶; D. Hraboš ⁷; J. Drábek ⁵; P. Kudlová ²; L. Hrabálek ¹
Authors‘ workplace: Neurochirurgická klinika LF UP a FN Olomouc ¹; Ústav zdravotnických věd FHS UTB ve Zlíně ²; Oddělení biomedicínského inženýrství, FN Olomouc ³; Ústav molekulární a translační medicíny, LF UP, Olomouc ⁴; Radiologická kliniky LF UP a FN Olomouc ⁵; Onkologická klinika LF UP a FN Olomouc ⁶; Ústav klinické a molekulární patologie, FN Olomouc ⁷
Published in: Cesk Slov Neurol N 2024; 87(1): 53-60
Category: Original Paper
doi: https://doi.org/10.48095/cccsnn202453

Overview

Aim: The aim of this study is to demonstrate the technical feasibility of volumetric assessment of residual tumor volume and to evaluate the effect of a precisely defined residual tumor volume on overall survival (OS) in patients with glioblastoma (GBM). Materials and methods: Adult patients who underwent surgical resection for GBM in the University Hospital Olomouc from 2012 to 2016 were selected retrospectively. Patients attended regular clinical and MRI follow-up every three months. Early postoperative MRI scans were used in the study. In each patient, tumor segmentation was performed followed by creating a 3D model of tumor volume, which allowed the calculation of its volume both before and after surgery. Results: Results of 50 patients were available for a retrospective analysis. Our study showed a significant prolongation of OS only in the group with no contrast-enhancing residue (median OS = 16.1 vs. 6.3 months) Patients with a combination of radical resection and oncological treatment with the Stupp protocol achieved further prolongation of OS with a mean of 19.6 months and a median of 14 months. Conclusion: Our paper describes the process of calculating the volume of the postoperative residual component of GBM using easily available software. According to the study findings, significantly better therapy results were achieved in patients with complete removal of the contrast-enhancing GBM component, supplemented by the most possible radical resection of the contrast non-enhancing components of the tumor.

Keywords:

overall survival – glioblastoma – postoperative residue

Sources

1. Louis DN, Perry A, Reifenberger G et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol 2016; 131 (6): 803–820. doi: 10.1007/s00401-016-15.

2. Konečná A, Netuka D. Difuzní nízkostupňové gliomy. Cesk Slov Neurol N 2020; 83/116 (5): 467–490. doi: 10.14735/amcsnn2020467.

3. Hendrych M, Valeková H, Kazda T et al. Integrated diagnostics of diffuse gliomas. Klin Onkol 2020; 33 (4): 248–259. doi: 10.14735/amko2020248.

4. Louis DN, Perry A, Wesseling P et al. The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Ann Oncol 2010; 21 (Suppl 5): v190ev193. doi: 10.1016/j.annonc.2010.08.016.

5. Lakomy R, Kazda T, Selingerova I et al. Real-world evidence in glioblastoma: Stupp’s regimen after a decade. Front Oncol 2020; 10: 840. doi: 10.3389/fonc.2020.00840.

6. Di L, Heath RN, Shah AH et al. Resection versus biopsy in the treatment of multifocal glioblastoma: a weighted survival analysis. J Neurooncol 2020; 148 (1): 155–164. doi: 10.1007/s11060-020-03508-6.

7. Halaj M, Kalita O, Tuckova L et al. Life expectancy in glioblastoma patients who had undergone stereotactic biopsy: a retrospective single-center study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023. doi: 10.5507/bp.2023.030.

8. Ushio Y, Kochi M, Hamada J et al. Effect of surgical removal on survival and quality of life in patients with supratentorial glioblastoma. Neurol Med Chir (Tokyo) 2005; 45 (9): 454–460; discussion 460–461. doi: 10.2176/nmc.45.454.

9. McGirt MJ, Chaichana KL, Gathinji M et al. Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg 2009; 110 (1): 156–162. doi: 10.3171/2008.4.17536.

10. Sanai N, Berger MS. Extent of resection influences outcomes for patients with gliomas. Rev Neurol (Paris) 2011; 167 (10): 648–654. doi: 10.1016/j.neurol.2011.07.004.

11. Que T, Huang G, Tan JE et al. Supramaximal resection based on en-bloc technique reduces tumor burden and prolongs survival in primary supratentorial lobar glioblastoma. J Neurooncol 2023; 164 (3): 557–568. doi: 10.1007/s11060-023-04399-z.

12. Karschnia P, Young JS, Dono A et al. Prognostic validation of a new classification system for extent of resection in glioblastoma: a report of the RANO resect group. Neuro Oncol 2023; 25 (5): 940–954. doi: 10.1093/neuonc/ noac193.

13. Orringer D, Lau D, Khatri S et al. Extent of resection in patients with glioblastoma: limiting factors, perception of resectability, and effect on survival. J Neurosurg 2012; 117 (5): 851–859. doi: 10.3171/2012.8.JNS12234.

14. McCarthy P. Source code for: FSLeyes Zenodo. [online]. Dostupné z: https: //zenodo.org/records/10122614.

15. Yushkevich PA, Piven J, Hazlett HC et al. User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage 2006; 31 (3): 1116–1128. doi: 10.1016/j.neuroimage.2006.01.015.

16. Sporikova Z, Slavkovsky R, Tuckova L et al. IDH1/2 mutations in patients with diffuse gliomas: a single centre retrospective massively parallel sequencing analysis. Appl Immunohistochem Mol Morphol 2022; 30 (1): 178–183. doi: 10.1097/PAI.0000000000000997.

17. Urbanovska I, Megova MH, Dwight Z et al. IDH mutation analysis in glioma patients by CADMA compared with SNaPshot assay and two immunohistochemical methods. Pathol Oncol Res 2019; 25 (4): 971–978. doi: 10.1007/s12253-018-0413-9.

18. Kalita O, Sporikova Z, Hajduch M et al. The influence of gene aberrations on survival in resected IDH wildtype glioblastoma patients: a single-institution study. Curr Oncol 2021; 28 (2): 1280–1293. doi: 10.3390/curroncol28020122.

19. Grabowski MM, Recinos PF, Nowacki AS et al. Residual tumor volume versus extent of resection: predictors of survival after surgery for glioblastoma. J Neurosurg 2014; 121 (5): 1115–1123. doi: 10.3171/2014.7.JNS132449.

20. Bjorland LS, Mahesparan R, Fluge Ø et al. Impact of extent of resection on outcome from glioblastoma using the RANO resect group classification system: a retrospective, population-based cohort study. Neurooncol Adv 2023; 5 (1): vdad126. doi: 10.1093/noajnl/vdad126.

21. Mendoza Mireles EE, Skaga E, Server A et al. The benefit of complete resection of contrast enhancing tumor in glioblastoma patients: a population-based study. Neurooncol Pract 2023; 10 (6): 555–564. doi: 10.1093/nop/npad037.

22. Giambra M, Di Cristofori A, Valtorta S et al. The peritumoral brain zone in glioblastoma: where we are and where we are going. J Neurosci Res 2023; 101 (2): 199–216. doi: 10.1002/jnr.25134.

23. Zarkoob H, Taube JH, Singh SK et al. Investigating the link between molecular subtypes of glioblastoma, epithelial-mesenchymal transition, and CD133 cell surface protein. PLoS One 2013; 8 (5): e64169. doi: 10.1371/journal.pone.0064169.

24. Karschnia P, Dietrich J, Bruno F et al. Surgical management and outcome of newly diagnosed glioblastoma without contrast enhancement (low grade appearance): a report of the RANO resect group. Neuro Oncol 2024; 26 (1): 166–177. doi: 10.1093/neuonc/noad160.

25. Brown TJ, Brennan MC, Li M et al. Association of the extent of resection with survival in glioblastoma: a systematic review and meta-analysis. JAMA Oncol 2016; 2 (11): 1460–1469. doi: 10.1001/jamaoncol.2016.1373.

26. Young JS, Morshed RA, Hervey-Jumper SL et al. The surgical management of diffuse gliomas: current state of neurosurgical management and future directions. Neuro Oncol 2023; 25 (12): 2117–2133. doi: 10.1093/neuonc/noad133.

27. Rahman M, Abbatematteo J, De Leo EK et al. The effects of new or worsened postoperative neurological deficits on survival of patients with glioblastoma. J Neurosurg 2017; 127 (1): 123–131. doi: 10.3171/2016.7.JNS16396.

28. Bartos R, Ospalik D, Malucelli A et al. Retrospektivní autoevaluace výsledků operací intrinsických mozkových nádorů – konsekutivní kohorta 270 operací v rámci jednoho neurochirurgického centra NOS ČOS (Neuroonkologické sekce České onkologické společnosti) z let 2015–2017. Cesk Slov Neurol N 2019; 82 (4): 401–409. doi: 10.14735/amcsnn2019401.