Volumetric extent of resection and residual contrast enhancement on initial surgery as predictors of outcome in adult patients with hemispheric anaplastic astrocytoma

View More View Less
  • 1 Department of Neurological Surgery, and Brain Tumor Research Center, University of California, San Francisco, California
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object

To investigate the prognostic significance of the volumetrically assessed extent of resection on time to tumor progression (TTP), overall survival (OS), and tumor recurrence patterns, the authors retrospectively analyzed preoperative and postoperative tumor volumes in 102 adult patients from the time of the initial resection of a hemispheric anaplastic astrocytoma (AA).

Methods

The quantification of tumor volumes was based on a previously described method involving computerized analysis of magnetic resonance (MR) images. Analysis of contrast-enhancing tumor volumes on T1-weighted MR images was conducted for 67 patients who had contrast-enhancing tumors. Measurements of T2 hyperintensity were obtained for all 102 patients in the study.

The presence or absence of preresection enhancement, actual volume of this enhancement, and the percentage of preoperative enhancement as it relates to the total T2 tumor volume did not have a statistically significant relationship to TTP or OS. In addition to age, the volume of residual disease measured on T2-weighted MR images was the most significant predictor of TTP (p < 0.001), and residual contrast-enhancing tumor volume was the most significant predictor of OS (p = 0.003) on multivariate analysis. In contrast to low-grade gliomas, there was no statistically significant relationship between the extent of resection and histological characteristics at the time of recurrence, that is, tumor Grade III compared with Grade IV.

Conclusions

Data from this retrospective analysis of a histologically uniform group of hemispheric AAs treated in the MR imaging era suggest that residual tumor volumes, as documented on postoperative imaging studies, may be a prognostic factor for TTP and OS for this patient population.

Abbreviations used in this paper:

AA = anaplastic astrocytoma; CI = confidence interval; GBM = glioblastoma multiforme; HR = hazard ratio; KPS = Karnofsky Performance Scale; MR = magnetic resonance; OS = overall survival; POR = percent of resection; RTOG = Radiation Therapy Oncology Group; TTP = time to tumor progression; VRD = volume of residual disease.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Berger MS, , Deliganis AV, , Dobbins J, & Keles GE: The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer 74:17841791, 1994

    • Search Google Scholar
    • Export Citation
  • 2

    Chamberlain MC, , Murovic JA, & Levin VA: Absence of contrast enhancement on CT brain scans of patients with supratentorial malignant gliomas. Neurology 38:13711374, 1988

    • Search Google Scholar
    • Export Citation
  • 3

    Curran WJ Jr, , Scott CB, , Horton J, , Nelson JS, , Weinstein AS, & Nelson DF, et al.: Does extent of surgery influence outcome for astro-cytoma with atypical or anaplastic foci (AAF)? A report from three Radiation Therapy Oncology Group (RTOG) trials. J Neurooncol 12:219227, 1992

    • Search Google Scholar
    • Export Citation
  • 4

    Daumas-Duport C, , Tucker ML, , Kolles H, , Cervera P, , Beuvon F, & Varlet P, et al.: Oligodendrogliomas. Part II: A new grading system based on morphological and imaging criteria. J Neurooncol 34:6178, 1997

    • Search Google Scholar
    • Export Citation
  • 5

    Donahue B, , Scott CB, , Nelson JS, , Rotman M, , Murray KJ, & Nelson DF, et al.: Influence of an oligodendroglial component on the survival of patients with anaplastic astrocytomas: a report of Radiation Therapy Oncology Group 83-02. Int J Radiat Oncol Biol Phys 38:911914, 1997

    • Search Google Scholar
    • Export Citation
  • 6

    Duong DH, , Rostomily RC, , Haynor DR, , Keles GE, & Berger MS: Measurement of tumor resection volumes from computerized images. Technical note. J Neurosurg 77:151154, 1992

    • Search Google Scholar
    • Export Citation
  • 7

    Ginsberg LE, , Fuller GN, , Hashmi M, , Leeds NE, & Schomer DF: The significance of lack of MR contrast enhancement of supratentorial brain tumors in adults: histopathological evaluation of a series. Surg Neurol 49:436440, 1998

    • Search Google Scholar
    • Export Citation
  • 8

    Hess KR: Extent of resection as a prognostic variable in the treatment of gliomas. J Neurooncol 42:227231, 1999

  • 9

    Keles GE, , Anderson B, & Berger MS: The effect of extent of resection on time to tumor progression and survival in patients with glioblastoma multiforme of the cerebral hemisphere. Surg Neurol 52:371379, 1999

    • Search Google Scholar
    • Export Citation
  • 10

    Keles GE, , Lamborn KR, & Berger MS: Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome. J Neurosurg 95:735745, 2001

    • Search Google Scholar
    • Export Citation
  • 11

    Keles GE, , Lamborn KR, , Chang SM, , Prados MD, & Berger MS: Volume of residual disease as a predictor of outcome in adult patients with recurrent supratentorial glioblastoma multiforme who are undergoing chemotherapy. J Neurosurg 100:4146, 2004

    • Search Google Scholar
    • Export Citation
  • 12

    Keles GE, , Lundin DA, , Lamborn KR, , Chang EF, , Ojemann G, & Berger MS: Intraoperative subcortical stimulation mapping for hemispheric perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients. J Neurosurg 100:369375, 2004

    • Search Google Scholar
    • Export Citation
  • 13

    Kleihues P, , Burger PC, & Scheithauer BW: The new WHO classification of brain tumours. Brain Pathol 3:255268, 1993

  • 14

    Kondziolka D, , Lunsford LD, & Martinez AJ: Unreliability of contemporary neurodiagnostic imaging in evaluating suspected adult supratentorial (low-grade) astrocytoma. J Neurosurg 79:533536, 1993

    • Search Google Scholar
    • Export Citation
  • 15

    Lacroix M, , Abi-Said D, , Fourney DR, , Gokaslan ZL, , Shi W, & DeMonte F, et al.: A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95:190198, 2001

    • Search Google Scholar
    • Export Citation
  • 16

    Laws ER, , Parney IF, , Huang W, , Anderson F, , Morris AM, & Asher A, et al.: Glioma Outcomes Investigators: Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project. J Neurosurg 99:467473, 2003

    • Search Google Scholar
    • Export Citation
  • 17

    Lev MH, , Ozsunar Y, , Henson JW, , Rasheed AA, , Barest GD, & Harsh GR IV, et al.: Glial tumor grading and outcome prediction using dynamic spin-echo MR susceptibility mapping compared with conventional contrast-enhanced MR: confounding effect of elevated rCBV of oligodendrogliomas. AJNR Am J Neuroradiol 25:214221, 2004

    • Search Google Scholar
    • Export Citation
  • 18

    Nazzaro JM, & Neuwelt EA: The role of surgery in the management of supratentorial intermediate and high-grade astrocytomas in adults. J Neurosurg 73:331344, 1990

    • Search Google Scholar
    • Export Citation
  • 19

    Nitta T, & Sato K: Prognostic implications of the extent of surgical resection in patients with intracranial malignant gliomas. Cancer 75:27272731, 1995

    • Search Google Scholar
    • Export Citation
  • 20

    Oh J, , Henry RG, , Pirzkall A, , Lu Y, , Li X, & Catalaa I, et al.: Survival analysis in patients with glioblastoma multiforme: predictive value of choline-to-N-acetylaspartate index, apparent diffusion coefficient, and relative cerebral blood volume. J Magn Reson Imaging 19:546554, 2004

    • Search Google Scholar
    • Export Citation
  • 21

    Pignatti F, , van den Bent M, , Curran D, , Debruyne C, , Sylvester R, & Therasse P, et al.: European Organization for Research and Treatment of Cancer Brain Tumor Cooperative Group; European Organization for Research and Treatment of Cancer Radiotherapy Cooperative Group: Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol 20:20762084, 2002

    • Search Google Scholar
    • Export Citation
  • 22

    Pirzkall A, , McKnight TR, , Graves EE, , Carol MP, , Sneed PK, & Wara WW, et al.: MR-spectroscopy guided target delineation for high-grade gliomas. Int J Radiat Oncol Biol Phys 50:915928, 2001

    • Search Google Scholar
    • Export Citation
  • 23

    Scott JN, , Brasher PMA, , Sevick RJ, , Rewcastle NB, & Forsyth PA: How often are nonenhancing supratentorial gliomas malignant? A population study. Neurology 59:947949, 2002

    • Search Google Scholar
    • Export Citation
  • 24

    Shibamoto Y, , Yamashita J, , Takahashi M, , Yamasaki T, , Kikuchi H, & Abe M: Supratentorial malignant glioma: an analysis of radiation therapy in 178 cases. Radiother Oncol 18:917, 1990

    • Search Google Scholar
    • Export Citation
  • 25

    Tortosa A, , Vinolas N, , Villa S, , Verger E, , Gil JM, & Brell M, et al.: Prognostic implication of clinical, radiologic, and pathologic features in patients with anaplastic gliomas. Cancer 97:10631071, 2003

    • Search Google Scholar
    • Export Citation
  • 26

    Wong ET, , Jackson EF, , Hess KR, , Schomer DF, , Hazle JD, & Kyritsis AP, et al.: Correlation between dynamic MRI and outcome in patients with malignant gliomas. Neurology 50:777781, 1998

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 568 151 5
Full Text Views 203 18 0
PDF Downloads 81 12 0
EPUB Downloads 0 0 0