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Annals of Surgical Oncology

, Volume 25, Supplement 3, pp 898–898 | Cite as

ASO Author Reflections: Size of Tumor Volume in Glioblastoma Patients

  • Stefanie Bette
  • Bernhard Meyer
  • Jens GemptEmail author
ASO Author Reflections
  • 105 Downloads

Past

For newly diagnosed glioblastoma, the mainstay of therapy is preferably complete resection of the contrast-enhancing tumor part, followed by the so-called Stupp scheme, a combined radiochemotherapy;1,2 however, incomplete tumor resection was questioned in a recent study.3 This study showed that gross total but not incomplete resection improves patients’ overall survival when treated with adjuvant radiochemotherapy. Therefore, incomplete resection is questionable, and, according to this study, biopsy might be an alternative treatment for patients with tumors in eloquent regions.3 The aim of this study was to assess the impact of pre- and postoperative tumor volume on overall survival, considering molecular status and adjuvant treatment regimens.

Present

The present study shows that not only complete resection of the contrast-enhancing tumor part but also incomplete resection improves overall survival of glioblastoma patients, considering adjuvant treatment regimens and O6-methylguanine-DNA-methyltransferase (MGMT) methylation status.4 These results therefore suggest—in contrast to the previous study3—to achieve a maximum safe tumor resection also in patients with tumors that cannot be completely resected due to infiltration of eloquent regions. Furthermore, our study assessed residual tumor volume instead of extent of resection, which is used in most oncological studies. Whereas extent of resection depends on preoperative tumor volume, residual tumor volume is an independent quantitative parameter for patients’ tumor burden. The importance of measuring postoperative tumor volume has also been shown in previous studies.5,6

Future

Prospective studies should be performed to assess molecular factors and adjuvant therapy regimens, not only extent of resection but also residual tumor volume, to address the prognostic value of incomplete tumor resection.

Notes

Disclosures

Stefanie Bette, Bernhard Meyer, and Jens Gempt are consultants for Brainlab AG, Munich.

References

  1. 1.
    Stummer W, et al. Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol. 2006;7:392–401.CrossRefGoogle Scholar
  2. 2.
    Stupp R, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987–996.CrossRefGoogle Scholar
  3. 3.
    Kreth FW, et al. Gross total but not incomplete resection of glioblastoma prolongs survival in the era of radiochemotherapy. Ann Oncol. 2013;24:3117–3123.CrossRefGoogle Scholar
  4. 4.
    Bette S, Barz M, Wiestler B, et al. Prognostic value of tumor volume in glioblastoma patients: size also matters for patients with incomplete resection. Ann Surg Oncol. 2018;25:558–564.CrossRefGoogle Scholar
  5. 5.
    Chaichana KL, et al. Establishing percent resection and residual volume thresholds affecting survival and recurrence for patients with newly diagnosed intracranial glioblastoma. Neuro Oncol. 2014;16:113–122.CrossRefGoogle Scholar
  6. 6.
    Grabowski MM, et al. Residual tumor volume versus extent of resection: predictors of survival after surgery for glioblastoma. J Neurosurg. 2014;121:1115–1123.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  1. 1.Department of NeuroradiologyKlinikum rechts der Isar der Technischen UniversitatMunichGermany
  2. 2.Department of NeurosurgeryKlinikum rechts der Isar der Technischen UniversitatMunichGermany

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