On the cutting edge of glioblastoma surgery: where neurosurgeons agree and disagree on surgical decisions

View More View Less
  • 1 Department of Neurosurgery, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam;
  • | 2 Department of Neurology and Neurosurgery, University Medical Center Utrecht;
  • | 3 Department of Neurosurgery, St. Elisabeth Hospital, Tilburg;
  • | 4 Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands;
  • | 5 Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom;
  • | 6 Neurosurgical Oncology Unit, Department of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy;
  • | 7 Department of Neurological Surgery, University of California, San Francisco, California;
  • | 8 Department of Neurosurgery, Medical Center Slotervaart, Amsterdam;
  • | 9 Department of Neurosurgery, Isala, Zwolle;
  • | 10 Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands;
  • | 11 Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Austria;
  • | 12 Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon;
  • | 13 Department of Neurosurgery, Northwest Clinics, Alkmaar, The Netherlands;
  • | 14 Department of Neurological Surgery, Medical University Vienna, Austria;
  • | 15 Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands;
  • | 16 Department of Neurological Surgery, Hôpital Lariboisière, Paris, France;
  • | 17 Department of Neurosurgery, University of Groningen, University Medical Center Groningen; and
  • | 18 Department of Clinical Epidemiology and Biostatistics, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
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

OBJECTIVE

The aim of glioblastoma surgery is to maximize the extent of resection while preserving functional integrity. Standards are lacking for surgical decision-making, and previous studies indicate treatment variations. These shortcomings reflect the need to evaluate larger populations from different care teams. In this study, the authors used probability maps to quantify and compare surgical decision-making throughout the brain by 12 neurosurgical teams for patients with glioblastoma.

METHODS

The study included all adult patients who underwent first-time glioblastoma surgery in 2012–2013 and were treated by 1 of the 12 participating neurosurgical teams. Voxel-wise probability maps of tumor location, biopsy, and resection were constructed for each team to identify and compare patient treatment variations. Brain regions with different biopsy and resection results between teams were identified and analyzed for patient functional outcome and survival.

RESULTS

The study cohort consisted of 1087 patients, of whom 363 underwent a biopsy and 724 a resection. Biopsy and resection decisions were generally comparable between teams, providing benchmarks for probability maps of resections and biopsies for glioblastoma. Differences in biopsy rates were identified for the right superior frontal gyrus and indicated variation in biopsy decisions. Differences in resection rates were identified for the left superior parietal lobule, indicating variations in resection decisions.

CONCLUSIONS

Probability maps of glioblastoma surgery enabled capture of clinical practice decisions and indicated that teams generally agreed on which region to biopsy or to resect. However, treatment variations reflecting clinical dilemmas were observed and pinpointed by using the probability maps, which could therefore be useful for quality-of-care discussions between surgical teams for patients with glioblastoma.

ABBREVIATIONS

ADC = apparent diffusion coefficient; ALK = Northwest Clinics, Alkmaar, the Netherlands; AMS = Amsterdam University Medical Centers, VU Medical Center, the Netherlands; DWI = diffusion-weighted imaging; GRO = University Medical Center Groningen, the Netherlands; HAG = Medical Center Haaglanden, The Hague, the Netherlands; KPS = Karnofsky Performance Status; MIL = Humanitas Research Hospital, Milano, Italy; MNI = Montreal Neurological Institute; PAR = Hôpital Lariboisière, Paris, France; SFR = University of California, San Francisco Medical Center, US; SLO = Medical Center Slotervaart, Amsterdam, the Netherlands; TIL = St. Elisabeth Hospital, Tilburg, the Netherlands; UTR = University Medical Center Utrecht, the Netherlands; VIE = Medical University Vienna, Austria; ZWO = Isala hospital, Zwolle, the Netherlands.

Supplementary Materials

    • Supplemental Figures and Tables (PDF 6,505 KB)

Illustration from Schneider et al. (pp 205–214). Copyright Elyssa Siegel. Published with permission.

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

USD  $515.00

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

USD  $612.00
  • 1

    Ostrom QT, Gittleman H, Truitt G, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2011–2015. Neuro Oncol. 2018;20(suppl 4):iv1iv86.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Weller M, van den Bent M, Hopkins K, et al. EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol. 2014;15(9):e395e403.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Scoccianti S, Magrini SM, Ricardi U, et al. Patterns of care and survival in a retrospective analysis of 1059 patients with glioblastoma multiforme treated between 2002 and 2007: a multicenter study by the Central Nervous System Study Group of Airo (Italian Association of Radiation Oncology). Neurosurgery. 2010;67(2):446458.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Bauchet L, Mathieu-Daudé H, Fabbro-Peray P, et al. Oncological patterns of care and outcome for 952 patients with newly diagnosed glioblastoma in 2004. Neuro Oncol. 2010;12(7):725735.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Chang SM, Parney IF, Huang W, et al. Patterns of care for adults with newly diagnosed malignant glioma. JAMA. 2005;293(5):557564.

  • 6

    Graus F, Bruna J, Pardo J, et al. Patterns of care and outcome for patients with glioblastoma diagnosed during 2008–2010 in Spain. Neuro Oncol. 2013;15(6):797805.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Asklund T, Malmström A, Bergqvist M, et al. Brain tumors in Sweden: data from a population-based registry 1999–2012. Acta Oncol. 2015;54(3):377384.

  • 8

    Yabroff KR, Harlan L, Zeruto C, et al. Patterns of care and survival for patients with glioblastoma multiforme diagnosed during 2006. Neuro Oncol. 2012;14(3):351359.

  • 9

    Sanai N, Berger MS. Surgical oncology for gliomas: the state of the art. Nat Rev Clin Oncol. 2018;15(2):112125.

  • 10

    De Witt Hamer PC, Hendriks EJ, Mandonnet E, et al. Resection probability maps for quality assessment of glioma surgery without brain location bias. PLoS One. 2013;8(9):e73353.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Müller DMJ, Robe PAJT, Eijgelaar RS, et al. Comparing glioblastoma surgery decisions between teams using brain maps of tumor locations, biopsies, and resections. JCO Clin Cancer Inform. 2019;3(3):CCI.18.00089.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):14531457.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Fonov V, Evans A, McKinstry R, et al. Unbiased nonlinear average age-appropriate brain templates from birth to adulthood. Neuroimage. 2009;47 S102.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Desikan RS, Ségonne F, Fischl B, et al. An automated labeling system for subdividing the human cerebral cortex on MRI scans into gyral based regions of interest. Neuroimage. 2006;31(3):968980.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Steltzer KJ, Sauvé KI, Spence AM, et al. Corpus callosum involvement as a prognostic factor for patients with high-grade astrocytoma. Int J Radiat Oncol Biol Phys. 1997;38(1):2730.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Opoku-Darko M, Amuah JE, Kelly JJP. Surgical resection of anterior and posterior butterfly glioblastoma. World Neurosurg. 2018;110:e612e620.

  • 17

    Burks JD, Bonney PA, Conner AK, et al. A method for safely resecting anterior butterfly gliomas: the surgical anatomy of the default mode network and the relevance of its preservation. J Neurosurg. 2017;126(6):17951811.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Dziurzynski K, Blas-Boria D, Suki D, et al. Butterfly glioblastomas: a retrospective review and qualitative assessment of outcomes. J Neurooncol. 2012;109(3):555563.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Chaichana KL, Jusue-Torres I, Lemos AM, et al. The butterfly effect on glioblastoma: is volumetric extent of resection more effective than biopsy for these tumors? J Neurooncol. 2014;120(3):625634.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Duffau H, Khalil I, Gatignol P, et al. Surgical removal of corpus callosum infiltrated by low-grade glioma: functional outcome and oncological considerations. J Neurosurg. 2004;100(3):431437.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Dayani F, Young JS, Bonte A, et al. Safety and outcomes of resection of butterfly glioblastoma. Neurosurg Focus. 2018;44(6):E4.

  • 22

    Lasocki A, Gaillard F, Tacey M, et al. Multifocal and multicentric glioblastoma: improved characterisation with FLAIR imaging and prognostic implications. J Clin Neurosci. 2016;31(92):98.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Patil CG, Yi A, Elramsisy A, et al. Prognosis of patients with multifocal glioblastoma: a case-control study. J Neurosurg. 2012;117(4):705711.

  • 24

    Hassaneen W, Levine NB, Suki D, et al. Multiple craniotomies in the management of multifocal and multicentric glioblastoma. Clinical article. J Neurosurg. 2011;114(3):576584.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Thomas RP, Xu LW, Lober RM, et al. The incidence and significance of multiple lesions in glioblastoma. J Neurooncol. 2013;112(1):9197.

  • 26

    Stummer W, Pichlmeier U, Meinel T, 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(5):392401.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    De Witt Hamer PC, Robles SG, Zwinderman AH, et al. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol. 2012;30(20):25592565.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Marko NF, Weil RJ, Schroeder JL, et al. Extent of resection of glioblastoma revisited: personalized survival modeling facilitates more accurate survival prediction and supports a maximum-safe-resection approach to surgery. J Clin Oncol. 2014;32(8):774782.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Ellingson BM, Cloughesy TF, Pope WB, et al. Anatomic localization of O6-methylguanine DNA methyltransferase (MGMT) promoter methylated and unmethylated tumors: a radiographic study in 358 de novo human glioblastomas. Neuroimage. 2012;59(2):908916.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Ellingson BM, Lai A, Harris RJ, et al. Probabilistic radiographic atlas of glioblastoma phenotypes. AJNR Am J Neuroradiol. 2013;34(3):533540.

  • 31

    Verburg N, Hoefnagels FWA, Barkhof F, et al. Diagnostic accuracy of neuroimaging to delineate diffuse gliomas within the brain: a meta-analysis. AJNR Am J Neuroradiol. 2017;38(10):18841891.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Wen PY, Macdonald DR, Reardon DA, et al. Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol. 2010;28(11):19631972.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33

    Ellingson BM, Wen PY, Cloughesy TF. Modified criteria for radiographic response assessment in glioblastoma clinical trials. Neurotherapeutics. 2017;14(2):307320.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Visser M, Müller DMJ, van Duijn RJM, et al. Inter-rater agreement in glioma segmentations on longitudinal MRI. Neuroimage Clin. 2019;22 101727.

Metrics

All Time Past Year Past 30 Days
Abstract Views 956 956 956
Full Text Views 190 190 190
PDF Downloads 247 247 247
EPUB Downloads 0 0 0