Abstract Date: 5/2/2015
Yan Michael Li, MD, PhD
Dima Suki, PhD
Raymond Sawaya, MD (Stockbridge, GA)
Introduction. Glioblastoma multiforme (GBM) is the most common and deadliest primary brain tumor. We review the survival of patients with significant extent of resection (EORs) and assess the relative benefit/risk of resecting 100% of the MRI region showing contrast-enhancement with or without additional resection of the surrounding FLAIR abnormality region,
Methods. The cohort included 1229 patients with histologically verified GBM in whom >78% resection was achieved at The University of Texas M. D. Anderson Cancer Center between June 1993 and December 2012. The survival of patients having 100% removal of the contrast-enhancing tumor, with or without additional resection the surrounding FLAIR abnormality region, was compared with that of patients undergoing 78% to <100% EOR of the enhancing mass.
Results. Complete resection of the T1 contrast-enhancing volume was achieved in 876 patients (71%). The median survival time of 15.2 months was significantly longer than that of patients undergoing less than complete resection (9.8months, p<0.001). This survival advantage was achieved without an increase in the risk of overall or neurological postoperative deficits, and after correcting for established prognostic factors including age, KPS, preoperative contrast-enhancing tumor volume, presence of necrosis and cyst, and prior treatment status. Additional analyses showed that resection of >53.21% of the surrounding FLAIR abnormality beyond the 100% contrast-enhancing resection was associated with prolonged survival compared with less extensive EORs (median survival times 20.7 vs 15.2months,p<0.001).
Conclusions. Based on what we believe to be the largest single-center series of GBM patients with extensive tumor resections, this study not only supports the established association between EOR and survival but also presents additional data that pushing the boundary of a conventional 100% resection by additional removal of a significant portion of the FLAIR abnormality region, when safely feasible, can result in additional prolongation of survival without significant increases in postoperative neurological morbidity.
Article ID: AA-31550