Perilesional Resection of Glioblastoma Is Independently Associated with Improved Outcomes

Wajd N. Al-Holou; Tiffany R. Hodges; Richard G. Everson; Jacob Freeman; Shouhao Zhou; Dima Suki; Ganesh Rao; Sherise D. Ferguson; Amy B. Heimberger; Ian E. McCutcheon; Sujit S. Prabhu; Frederick F. Lang; Jeffrey S. Weinberg; David M. Wildrick; Raymond Sawaya

doi:10.1093/neuros/nyz008

Perilesional Resection of Glioblastoma Is Independently Associated with Improved Outcomes

Wajd N. Al-Holou, Tiffany R. Hodges, Richard G. Everson, Jacob Freeman, Shouhao Zhou, Dima Suki, Ganesh Rao, Sherise D. Ferguson, Amy B. Heimberger, Ian E. McCutcheon, Sujit S. Prabhu, Frederick F. Lang, Jeffrey S. Weinberg, David M. Wildrick, Raymond Sawaya

Research output: Contribution to journal › Article › peer-review

33 Scopus citations

Abstract

BACKGROUND: Resection is a critical component in the initial treatment of glioblastoma (GBM). Often GBMs are resected using an intralesional method. Circumferential perilesional resection of GBMs has been described, but with limited data. OBJECTIVE: To conduct an observational retrospective analysis to test whether perilesional resection produced a greater extent of resection. METHODS: We identified all patients with newly diagnosed GBM who underwent resection at our institution from June 1, 1993 to December 31, 2015. Demographics, presenting symptoms, intraoperative data, method of resection (perilesional or intralesional), volumetric imaging data, and postoperative outcomes were obtained. Complete resection (CR) was defined as 100% resection of all contrast-enhancing disease. Univariate analyses employed analysis of variance (ANOVA) and Fisher's exact test. Multivariate analyses used propensity score-weighted multivariate logistic regression. RESULTS: Newly diagnosed GBMs were resected in 1204 patients, 436 tumors (36%) perilesionally and 766 (64%) intralesionally. Radiographic CR was achieved in 69% of cases. Multivariate analysis demonstrated that perilesional tumor resection was associated with a significantly higher rate of CR than intralesional resection (81% vs 62%, multivariate odds ratio = 2.5, 95% confidence interval: 1.8-3.4, P <. 001). Among tumors in eloquent cortex, multivariate analysis showed that patients who underwent perilesional resection had a higher rate of CR (79% vs 58%, respectively, P <. 001) and a lower rate of neurological complications (11% vs 20%, respectively, P =. 018) than those who underwent intralesional resection. CONCLUSION: Circumferential perilesional resection of GBM is associated with significantly higher rates of CR and lower rates of neurological complications than intralesional resection, even for tumors arising in eloquent locations. Perilesional resection, when feasible, should be considered as a preferred option.

Original language	English (US)
Pages (from-to)	112-121
Number of pages	10
Journal	Neurosurgery
Volume	86
Issue number	1
DOIs	https://doi.org/10.1093/neuros/nyz008
State	Published - Jan 1 2020

Keywords

Circumferential dissection
Extent of resection
Glioblastoma
Intralesional resection
Neurological complications
Perilesional

ASJC Scopus subject areas

Surgery
Clinical Neurology

MD Anderson CCSG core facilities

Biostatistics Resource Group

Access to Document

10.1093/neuros/nyz008

Cite this

Al-Holou, W. N., Hodges, T. R., Everson, R. G., Freeman, J., Zhou, S., Suki, D., Rao, G., Ferguson, S. D., Heimberger, A. B., McCutcheon, I. E., Prabhu, S. S., Lang, F. F., Weinberg, J. S., Wildrick, D. M., & Sawaya, R. (2020). Perilesional Resection of Glioblastoma Is Independently Associated with Improved Outcomes. Neurosurgery, 86(1), 112-121. https://doi.org/10.1093/neuros/nyz008

@article{11e3a58d40374ba687a73049294a7527,

title = "Perilesional Resection of Glioblastoma Is Independently Associated with Improved Outcomes",

abstract = "BACKGROUND: Resection is a critical component in the initial treatment of glioblastoma (GBM). Often GBMs are resected using an intralesional method. Circumferential perilesional resection of GBMs has been described, but with limited data. OBJECTIVE: To conduct an observational retrospective analysis to test whether perilesional resection produced a greater extent of resection. METHODS: We identified all patients with newly diagnosed GBM who underwent resection at our institution from June 1, 1993 to December 31, 2015. Demographics, presenting symptoms, intraoperative data, method of resection (perilesional or intralesional), volumetric imaging data, and postoperative outcomes were obtained. Complete resection (CR) was defined as 100% resection of all contrast-enhancing disease. Univariate analyses employed analysis of variance (ANOVA) and Fisher's exact test. Multivariate analyses used propensity score-weighted multivariate logistic regression. RESULTS: Newly diagnosed GBMs were resected in 1204 patients, 436 tumors (36%) perilesionally and 766 (64%) intralesionally. Radiographic CR was achieved in 69% of cases. Multivariate analysis demonstrated that perilesional tumor resection was associated with a significantly higher rate of CR than intralesional resection (81% vs 62%, multivariate odds ratio = 2.5, 95% confidence interval: 1.8-3.4, P <. 001). Among tumors in eloquent cortex, multivariate analysis showed that patients who underwent perilesional resection had a higher rate of CR (79% vs 58%, respectively, P <. 001) and a lower rate of neurological complications (11% vs 20%, respectively, P =. 018) than those who underwent intralesional resection. CONCLUSION: Circumferential perilesional resection of GBM is associated with significantly higher rates of CR and lower rates of neurological complications than intralesional resection, even for tumors arising in eloquent locations. Perilesional resection, when feasible, should be considered as a preferred option.",

keywords = "Circumferential dissection, Extent of resection, Glioblastoma, Intralesional resection, Neurological complications, Perilesional",

author = "Al-Holou, {Wajd N.} and Hodges, {Tiffany R.} and Everson, {Richard G.} and Jacob Freeman and Shouhao Zhou and Dima Suki and Ganesh Rao and Ferguson, {Sherise D.} and Heimberger, {Amy B.} and McCutcheon, {Ian E.} and Prabhu, {Sujit S.} and Lang, {Frederick F.} and Weinberg, {Jeffrey S.} and Wildrick, {David M.} and Raymond Sawaya",

note = "Publisher Copyright: Copyright {\textcopyright} 2019 by the Congress of Neurological Surgeons.",

year = "2020",

month = jan,

day = "1",

doi = "10.1093/neuros/nyz008",

language = "English (US)",

volume = "86",

pages = "112--121",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "1",

}

TY - JOUR

T1 - Perilesional Resection of Glioblastoma Is Independently Associated with Improved Outcomes

AU - Al-Holou, Wajd N.

AU - Hodges, Tiffany R.

AU - Everson, Richard G.

AU - Freeman, Jacob

AU - Zhou, Shouhao

AU - Suki, Dima

AU - Rao, Ganesh

AU - Ferguson, Sherise D.

AU - Heimberger, Amy B.

AU - McCutcheon, Ian E.

AU - Prabhu, Sujit S.

AU - Lang, Frederick F.

AU - Weinberg, Jeffrey S.

AU - Wildrick, David M.

AU - Sawaya, Raymond

PY - 2020/1/1

Y1 - 2020/1/1

N2 - BACKGROUND: Resection is a critical component in the initial treatment of glioblastoma (GBM). Often GBMs are resected using an intralesional method. Circumferential perilesional resection of GBMs has been described, but with limited data. OBJECTIVE: To conduct an observational retrospective analysis to test whether perilesional resection produced a greater extent of resection. METHODS: We identified all patients with newly diagnosed GBM who underwent resection at our institution from June 1, 1993 to December 31, 2015. Demographics, presenting symptoms, intraoperative data, method of resection (perilesional or intralesional), volumetric imaging data, and postoperative outcomes were obtained. Complete resection (CR) was defined as 100% resection of all contrast-enhancing disease. Univariate analyses employed analysis of variance (ANOVA) and Fisher's exact test. Multivariate analyses used propensity score-weighted multivariate logistic regression. RESULTS: Newly diagnosed GBMs were resected in 1204 patients, 436 tumors (36%) perilesionally and 766 (64%) intralesionally. Radiographic CR was achieved in 69% of cases. Multivariate analysis demonstrated that perilesional tumor resection was associated with a significantly higher rate of CR than intralesional resection (81% vs 62%, multivariate odds ratio = 2.5, 95% confidence interval: 1.8-3.4, P <. 001). Among tumors in eloquent cortex, multivariate analysis showed that patients who underwent perilesional resection had a higher rate of CR (79% vs 58%, respectively, P <. 001) and a lower rate of neurological complications (11% vs 20%, respectively, P =. 018) than those who underwent intralesional resection. CONCLUSION: Circumferential perilesional resection of GBM is associated with significantly higher rates of CR and lower rates of neurological complications than intralesional resection, even for tumors arising in eloquent locations. Perilesional resection, when feasible, should be considered as a preferred option.

AB - BACKGROUND: Resection is a critical component in the initial treatment of glioblastoma (GBM). Often GBMs are resected using an intralesional method. Circumferential perilesional resection of GBMs has been described, but with limited data. OBJECTIVE: To conduct an observational retrospective analysis to test whether perilesional resection produced a greater extent of resection. METHODS: We identified all patients with newly diagnosed GBM who underwent resection at our institution from June 1, 1993 to December 31, 2015. Demographics, presenting symptoms, intraoperative data, method of resection (perilesional or intralesional), volumetric imaging data, and postoperative outcomes were obtained. Complete resection (CR) was defined as 100% resection of all contrast-enhancing disease. Univariate analyses employed analysis of variance (ANOVA) and Fisher's exact test. Multivariate analyses used propensity score-weighted multivariate logistic regression. RESULTS: Newly diagnosed GBMs were resected in 1204 patients, 436 tumors (36%) perilesionally and 766 (64%) intralesionally. Radiographic CR was achieved in 69% of cases. Multivariate analysis demonstrated that perilesional tumor resection was associated with a significantly higher rate of CR than intralesional resection (81% vs 62%, multivariate odds ratio = 2.5, 95% confidence interval: 1.8-3.4, P <. 001). Among tumors in eloquent cortex, multivariate analysis showed that patients who underwent perilesional resection had a higher rate of CR (79% vs 58%, respectively, P <. 001) and a lower rate of neurological complications (11% vs 20%, respectively, P =. 018) than those who underwent intralesional resection. CONCLUSION: Circumferential perilesional resection of GBM is associated with significantly higher rates of CR and lower rates of neurological complications than intralesional resection, even for tumors arising in eloquent locations. Perilesional resection, when feasible, should be considered as a preferred option.

KW - Circumferential dissection

KW - Extent of resection

KW - Glioblastoma

KW - Intralesional resection

KW - Neurological complications

KW - Perilesional

UR - http://www.scopus.com/inward/record.url?scp=85076539802&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85076539802&partnerID=8YFLogxK

U2 - 10.1093/neuros/nyz008

DO - 10.1093/neuros/nyz008

M3 - Article

C2 - 30799490

AN - SCOPUS:85076539802

SN - 0148-396X

VL - 86

SP - 112

EP - 121

JO - Neurosurgery

JF - Neurosurgery

IS - 1

ER -

Perilesional Resection of Glioblastoma Is Independently Associated with Improved Outcomes

Abstract

Keywords

ASJC Scopus subject areas

MD Anderson CCSG core facilities

Access to Document

Other files and links

Fingerprint

Cite this