학술논문
Intraoperative MRI for newly diagnosed supratentorial glioblastoma: a multicenter-registry comparative study to conventional surgery.
Document Type
Academic Journal
Author
Shah AS; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Sylvester PT; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Yahanda AT; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Vellimana AK; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Dunn GP; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Evans J; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Rich KM; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Dowling JL; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Leuthardt EC; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Dacey RG; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Kim AH; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Grubb RL; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Zipfel GJ; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Oswood M; 2Department of Radiology, University of Minnesota, Minneapolis, Minnesota.; 3Allina Health, Minneapolis, Minnesota.; Jensen RL; 4Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.; Sutherland GR; 5Department of Clinical Sciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada.; Cahill DP; 6Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.; Abram SR; 7Department of Neurosurgery, St. Thomas Hospital, Nashville, Tennessee.; Honeycutt J; 8Department of Neurosurgery, Cook Children's Hospital, Fort Worth, Texas; and.; Shah M; 9Department of Neurological Surgery, Goodman Campbell and Indiana University, Indianapolis, Indiana.; Tao Y; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Chicoine MR; 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.
Source
Publisher: American Association of Neurological Surgeons Country of Publication: United States NLM ID: 0253357 Publication Model: Electronic Cited Medium: Internet ISSN: 1933-0693 (Electronic) Linking ISSN: 00223085 NLM ISO Abbreviation: J Neurosurg Subsets: PubMed not MEDLINE; MEDLINE
Subject
Language
English
Abstract
Objective: Intraoperative MRI (iMRI) is used in the surgical treatment of glioblastoma, with uncertain effects on outcomes. The authors evaluated the impact of iMRI on extent of resection (EOR) and overall survival (OS) while controlling for other known and suspected predictors.
Methods: A multicenter retrospective cohort of 640 adult patients with newly diagnosed supratentorial glioblastoma who underwent resection was evaluated. iMRI was performed in 332/640 cases (51.9%). Reviews of MRI features and tumor volumetric analysis were performed on a subsample of cases (n = 286; 110 non-iMRI, 176 iMRI) from a single institution.
Results: The median age was 60.0 years (mean 58.5 years, range 20.5-86.3 years). The median OS was 17.0 months (95% CI 15.6-18.4 months). Gross-total resection (GTR) was achieved in 403/640 cases (63.0%). Kaplan-Meier analysis of 286 cases with volumetric analysis for EOR (grouped into 100%, 95%-99%, 80%-94%, and 50%-79%) showed longer OS for 100% EOR compared to all other groups (p < 0.01). Additional resection after iMRI was performed in 104/122 cases (85.2%) with initial subtotal resection (STR), leading to a 6.3% mean increase in EOR and a 2.2-cm3 mean decrease in tumor volume. For iMRI cases with volumetric analysis, the GTR rate increased from 54/176 (30.7%) on iMRI to 126/176 (71.5%) postoperatively. The EOR was significantly higher in the iMRI group for intended GTR and STR groups (p = 0.02 and p < 0.01, respectively). Predictors of GTR on multivariate logistic regression included iMRI use and intended GTR. Predictors of shorter OS on multivariate Cox regression included older age, STR, isocitrate dehydrogenase 1 (IDH1) wild type, no O 6-methylguanine DNA methyltransferase (MGMT) methylation, and no Stupp therapy. iMRI was a significant predictor of OS on univariate (HR 0.82, 95% CI 0.69-0.98; p = 0.03) but not multivariate analyses. Use of iMRI was not associated with an increased rate of new permanent neurological deficits.
Conclusions: GTR increased OS for patients with newly diagnosed glioblastoma after adjusting for other prognostic factors. iMRI increased EOR and GTR rate and was a significant predictor of GTR on multivariate analysis; however, iMRI was not an independent predictor of OS. Additional supporting evidence is needed to determine the clinical benefit of iMRI in the management of glioblastoma.
Methods: A multicenter retrospective cohort of 640 adult patients with newly diagnosed supratentorial glioblastoma who underwent resection was evaluated. iMRI was performed in 332/640 cases (51.9%). Reviews of MRI features and tumor volumetric analysis were performed on a subsample of cases (n = 286; 110 non-iMRI, 176 iMRI) from a single institution.
Results: The median age was 60.0 years (mean 58.5 years, range 20.5-86.3 years). The median OS was 17.0 months (95% CI 15.6-18.4 months). Gross-total resection (GTR) was achieved in 403/640 cases (63.0%). Kaplan-Meier analysis of 286 cases with volumetric analysis for EOR (grouped into 100%, 95%-99%, 80%-94%, and 50%-79%) showed longer OS for 100% EOR compared to all other groups (p < 0.01). Additional resection after iMRI was performed in 104/122 cases (85.2%) with initial subtotal resection (STR), leading to a 6.3% mean increase in EOR and a 2.2-cm3 mean decrease in tumor volume. For iMRI cases with volumetric analysis, the GTR rate increased from 54/176 (30.7%) on iMRI to 126/176 (71.5%) postoperatively. The EOR was significantly higher in the iMRI group for intended GTR and STR groups (p = 0.02 and p < 0.01, respectively). Predictors of GTR on multivariate logistic regression included iMRI use and intended GTR. Predictors of shorter OS on multivariate Cox regression included older age, STR, isocitrate dehydrogenase 1 (IDH1) wild type, no O 6-methylguanine DNA methyltransferase (MGMT) methylation, and no Stupp therapy. iMRI was a significant predictor of OS on univariate (HR 0.82, 95% CI 0.69-0.98; p = 0.03) but not multivariate analyses. Use of iMRI was not associated with an increased rate of new permanent neurological deficits.
Conclusions: GTR increased OS for patients with newly diagnosed glioblastoma after adjusting for other prognostic factors. iMRI increased EOR and GTR rate and was a significant predictor of GTR on multivariate analysis; however, iMRI was not an independent predictor of OS. Additional supporting evidence is needed to determine the clinical benefit of iMRI in the management of glioblastoma.