Glioblastoma surgery with and without intraoperative MRI at 3.0T
Abstract Background Gross total or near total resection (GTR/NTR; resection ≥ 95%) of glioblastoma (GBM) seems correlated with a longer survival. Intraoperative MRI (ioMRI) is one method to evaluate the extent of resection (EOR) in order to improve it during the same anesthesia. We compared GBM rese...
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| Veröffentlicht in: | Neuro-chirurgie 2014-08, Vol.60 (4), p.143-150 |
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| description | Abstract Background Gross total or near total resection (GTR/NTR; resection ≥ 95%) of glioblastoma (GBM) seems correlated with a longer survival. Intraoperative MRI (ioMRI) is one method to evaluate the extent of resection (EOR) in order to improve it during the same anesthesia. We compared GBM resections using a 3.0T ioMRI and then without considering the EOR, safety, survival and discussed the indications for using this expensive modality. Methods Between March 2006 and November 2011, 56 GBM resections were performed using an ioMRI, and 38 without (control group). The only criterion in order to have access to the ioMRI was its availability. We compared the variables EOR, Karnofsky Performance Scale scores and survival in both groups. Results In the ioMRI group, 15 patients (26.8%) underwent an immediate second resection increasing the GTR rate of 10.7% and the GTR/NTR rate of 8.9%. There was a significant difference between the use of an ioMRI and the control group in reaching a larger EOR ( P = 0.049, Fisher's exact test). The effect of using the ioMRI or not on the overall survival, with EOR as covariate, was not significant ( P = 0.147, Likelihood ratio test). However, the EOR alone had a significant effect on survival ( P = 0.049, Wald test), with a shorter survival for the patients with a partial resection (PR) than a GTR/NTR (Hazard ratio = 1.6, 95% CI HR: 1.00–2.69), with a median overall survival of 15.26 months (95% CI: 12.34–19.08) for the GTR/NTR subgroup versus 10.26 months (95% CI: 6.64–15.82) for the PR subgroup. Multivariate regression analysis also identified age, sex and adjuvant chemotherapy as factors significantly associated with overall survival. Conclusions A 3.0T ioMRI improved the quality of resection by 17.8% and increased the GTR/NTR rate by 8.9% up to 73.2% without additional morbidity. A GTR/NTR improves survival duration by about 50%. Thus, it remains reasonable to increase the EOR to reach GTR/NTR using an intraoperative control. However, ioMRI should be limited to the cases for which a GTR/NTR seems preoperatively possible. |
| doi_str_mv | 10.1016/j.neuchi.2014.03.010 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1552370224</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0028377014000642</els_id><sourcerecordid>1552370224</sourcerecordid><originalsourceid>FETCH-LOGICAL-c517t-4f82c3fab1ce27f65da03e9af27daecb4656f7aff328006420ec434efc72fe9b3</originalsourceid><addsrcrecordid>eNqFkU1r3DAQhkVpaTZp_0EpvhR6sTv6sGVfQkJok0BKoU3PQpZHjTZeayPJCfvvq81uEuilp9HAM_OKZwj5QKGiQJsvy2rC2dy4igEVFfAKKLwiCyolL6Gh3WuyAGBtyaWEA3IY4zK3tG7gLTlgopM1A7kgJ-ej8_2oY_IrXcQ5_MGwKR5cuin0NDw-_JwKN6Wg_RqDTu4ei-8_Lwudipx5_Y68sXqM-H5fj8jvb1-vzy7Kqx_nl2enV6WpqUylsC0z3OqeGmTSNvWggWOnLZODRtOLpm6s1NZy1gI0ggEawQVaI5nFrudH5PNu7zr4uxljUisXDY6jntDPUdG6ZlwCYyKjYoea4GMMaNU6uJUOG0VBbd2ppdq5U1t3CrjK7vLYx33C3K9weB56kpWBT3tAR6NHG_RkXHzhWgmUdm3mjnccZh_3DoOKxuFkcHABTVKDd__7yb8LzOgmlzNvcYNx6ecwZdeKqsgUqF_bO2_PTAU8uuN_AQWfovI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1552370224</pqid></control><display><type>article</type><title>Glioblastoma surgery with and without intraoperative MRI at 3.0T</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Napolitano, M ; Vaz, G ; Lawson, T.M ; Docquier, M.-A ; van Maanen, A ; Duprez, T ; Raftopoulos, C</creator><creatorcontrib>Napolitano, M ; Vaz, G ; Lawson, T.M ; Docquier, M.-A ; van Maanen, A ; Duprez, T ; Raftopoulos, C</creatorcontrib><description>Abstract Background Gross total or near total resection (GTR/NTR; resection ≥ 95%) of glioblastoma (GBM) seems correlated with a longer survival. Intraoperative MRI (ioMRI) is one method to evaluate the extent of resection (EOR) in order to improve it during the same anesthesia. We compared GBM resections using a 3.0T ioMRI and then without considering the EOR, safety, survival and discussed the indications for using this expensive modality. Methods Between March 2006 and November 2011, 56 GBM resections were performed using an ioMRI, and 38 without (control group). The only criterion in order to have access to the ioMRI was its availability. We compared the variables EOR, Karnofsky Performance Scale scores and survival in both groups. Results In the ioMRI group, 15 patients (26.8%) underwent an immediate second resection increasing the GTR rate of 10.7% and the GTR/NTR rate of 8.9%. There was a significant difference between the use of an ioMRI and the control group in reaching a larger EOR ( P = 0.049, Fisher's exact test). The effect of using the ioMRI or not on the overall survival, with EOR as covariate, was not significant ( P = 0.147, Likelihood ratio test). However, the EOR alone had a significant effect on survival ( P = 0.049, Wald test), with a shorter survival for the patients with a partial resection (PR) than a GTR/NTR (Hazard ratio = 1.6, 95% CI HR: 1.00–2.69), with a median overall survival of 15.26 months (95% CI: 12.34–19.08) for the GTR/NTR subgroup versus 10.26 months (95% CI: 6.64–15.82) for the PR subgroup. Multivariate regression analysis also identified age, sex and adjuvant chemotherapy as factors significantly associated with overall survival. Conclusions A 3.0T ioMRI improved the quality of resection by 17.8% and increased the GTR/NTR rate by 8.9% up to 73.2% without additional morbidity. A GTR/NTR improves survival duration by about 50%. Thus, it remains reasonable to increase the EOR to reach GTR/NTR using an intraoperative control. However, ioMRI should be limited to the cases for which a GTR/NTR seems preoperatively possible.</description><identifier>ISSN: 0028-3770</identifier><identifier>EISSN: 1773-0619</identifier><identifier>DOI: 10.1016/j.neuchi.2014.03.010</identifier><identifier>PMID: 24975207</identifier><identifier>CODEN: NUREB9</identifier><language>eng</language><publisher>Paris: Elsevier Masson SAS</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Brain Neoplasms - pathology ; Brain Neoplasms - surgery ; Combined Modality Therapy ; Extent of resection ; Female ; Glioblastoma ; Glioblastoma - pathology ; Glioblastoma - surgery ; Glioblastome ; High-field MRI ; Humans ; Imagerie par résonance magnétique per-opératoire ; Intraoperative magnetic resonance imaging ; IRM à champ élevé ; Karnofsky Performance Status ; Magnetic Resonance Imaging - methods ; Male ; Medical sciences ; Middle Aged ; Neoplasm, Residual - pathology ; Neoplasm, Residual - surgery ; Neurosurgery ; Neurosurgical Procedures - adverse effects ; Neurosurgical Procedures - methods ; Reoperation - statistics & numerical data ; Retrospective Studies ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery, Computer-Assisted - adverse effects ; Surgery, Computer-Assisted - methods ; Survie ; Survival ; Survival Analysis ; Young Adult ; Étendue de résection</subject><ispartof>Neuro-chirurgie, 2014-08, Vol.60 (4), p.143-150</ispartof><rights>Elsevier Masson SAS</rights><rights>2014 Elsevier Masson SAS</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2014 Elsevier Masson SAS. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c517t-4f82c3fab1ce27f65da03e9af27daecb4656f7aff328006420ec434efc72fe9b3</citedby><cites>FETCH-LOGICAL-c517t-4f82c3fab1ce27f65da03e9af27daecb4656f7aff328006420ec434efc72fe9b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0028377014000642$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28701198$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24975207$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Napolitano, M</creatorcontrib><creatorcontrib>Vaz, G</creatorcontrib><creatorcontrib>Lawson, T.M</creatorcontrib><creatorcontrib>Docquier, M.-A</creatorcontrib><creatorcontrib>van Maanen, A</creatorcontrib><creatorcontrib>Duprez, T</creatorcontrib><creatorcontrib>Raftopoulos, C</creatorcontrib><title>Glioblastoma surgery with and without intraoperative MRI at 3.0T</title><title>Neuro-chirurgie</title><addtitle>Neurochirurgie</addtitle><description>Abstract Background Gross total or near total resection (GTR/NTR; resection ≥ 95%) of glioblastoma (GBM) seems correlated with a longer survival. Intraoperative MRI (ioMRI) is one method to evaluate the extent of resection (EOR) in order to improve it during the same anesthesia. We compared GBM resections using a 3.0T ioMRI and then without considering the EOR, safety, survival and discussed the indications for using this expensive modality. Methods Between March 2006 and November 2011, 56 GBM resections were performed using an ioMRI, and 38 without (control group). The only criterion in order to have access to the ioMRI was its availability. We compared the variables EOR, Karnofsky Performance Scale scores and survival in both groups. Results In the ioMRI group, 15 patients (26.8%) underwent an immediate second resection increasing the GTR rate of 10.7% and the GTR/NTR rate of 8.9%. There was a significant difference between the use of an ioMRI and the control group in reaching a larger EOR ( P = 0.049, Fisher's exact test). The effect of using the ioMRI or not on the overall survival, with EOR as covariate, was not significant ( P = 0.147, Likelihood ratio test). However, the EOR alone had a significant effect on survival ( P = 0.049, Wald test), with a shorter survival for the patients with a partial resection (PR) than a GTR/NTR (Hazard ratio = 1.6, 95% CI HR: 1.00–2.69), with a median overall survival of 15.26 months (95% CI: 12.34–19.08) for the GTR/NTR subgroup versus 10.26 months (95% CI: 6.64–15.82) for the PR subgroup. Multivariate regression analysis also identified age, sex and adjuvant chemotherapy as factors significantly associated with overall survival. Conclusions A 3.0T ioMRI improved the quality of resection by 17.8% and increased the GTR/NTR rate by 8.9% up to 73.2% without additional morbidity. A GTR/NTR improves survival duration by about 50%. Thus, it remains reasonable to increase the EOR to reach GTR/NTR using an intraoperative control. However, ioMRI should be limited to the cases for which a GTR/NTR seems preoperatively possible.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Brain Neoplasms - pathology</subject><subject>Brain Neoplasms - surgery</subject><subject>Combined Modality Therapy</subject><subject>Extent of resection</subject><subject>Female</subject><subject>Glioblastoma</subject><subject>Glioblastoma - pathology</subject><subject>Glioblastoma - surgery</subject><subject>Glioblastome</subject><subject>High-field MRI</subject><subject>Humans</subject><subject>Imagerie par résonance magnétique per-opératoire</subject><subject>Intraoperative magnetic resonance imaging</subject><subject>IRM à champ élevé</subject><subject>Karnofsky Performance Status</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoplasm, Residual - pathology</subject><subject>Neoplasm, Residual - surgery</subject><subject>Neurosurgery</subject><subject>Neurosurgical Procedures - adverse effects</subject><subject>Neurosurgical Procedures - methods</subject><subject>Reoperation - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery, Computer-Assisted - adverse effects</subject><subject>Surgery, Computer-Assisted - methods</subject><subject>Survie</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>Young Adult</subject><subject>Étendue de résection</subject><issn>0028-3770</issn><issn>1773-0619</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1r3DAQhkVpaTZp_0EpvhR6sTv6sGVfQkJok0BKoU3PQpZHjTZeayPJCfvvq81uEuilp9HAM_OKZwj5QKGiQJsvy2rC2dy4igEVFfAKKLwiCyolL6Gh3WuyAGBtyaWEA3IY4zK3tG7gLTlgopM1A7kgJ-ej8_2oY_IrXcQ5_MGwKR5cuin0NDw-_JwKN6Wg_RqDTu4ei-8_Lwudipx5_Y68sXqM-H5fj8jvb1-vzy7Kqx_nl2enV6WpqUylsC0z3OqeGmTSNvWggWOnLZODRtOLpm6s1NZy1gI0ggEawQVaI5nFrudH5PNu7zr4uxljUisXDY6jntDPUdG6ZlwCYyKjYoea4GMMaNU6uJUOG0VBbd2ppdq5U1t3CrjK7vLYx33C3K9weB56kpWBT3tAR6NHG_RkXHzhWgmUdm3mjnccZh_3DoOKxuFkcHABTVKDd__7yb8LzOgmlzNvcYNx6ecwZdeKqsgUqF_bO2_PTAU8uuN_AQWfovI</recordid><startdate>20140801</startdate><enddate>20140801</enddate><creator>Napolitano, M</creator><creator>Vaz, G</creator><creator>Lawson, T.M</creator><creator>Docquier, M.-A</creator><creator>van Maanen, A</creator><creator>Duprez, T</creator><creator>Raftopoulos, C</creator><general>Elsevier Masson SAS</general><general>Masson</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140801</creationdate><title>Glioblastoma surgery with and without intraoperative MRI at 3.0T</title><author>Napolitano, M ; Vaz, G ; Lawson, T.M ; Docquier, M.-A ; van Maanen, A ; Duprez, T ; Raftopoulos, C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c517t-4f82c3fab1ce27f65da03e9af27daecb4656f7aff328006420ec434efc72fe9b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Brain Neoplasms - pathology</topic><topic>Brain Neoplasms - surgery</topic><topic>Combined Modality Therapy</topic><topic>Extent of resection</topic><topic>Female</topic><topic>Glioblastoma</topic><topic>Glioblastoma - pathology</topic><topic>Glioblastoma - surgery</topic><topic>Glioblastome</topic><topic>High-field MRI</topic><topic>Humans</topic><topic>Imagerie par résonance magnétique per-opératoire</topic><topic>Intraoperative magnetic resonance imaging</topic><topic>IRM à champ élevé</topic><topic>Karnofsky Performance Status</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neoplasm, Residual - pathology</topic><topic>Neoplasm, Residual - surgery</topic><topic>Neurosurgery</topic><topic>Neurosurgical Procedures - adverse effects</topic><topic>Neurosurgical Procedures - methods</topic><topic>Reoperation - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery, Computer-Assisted - adverse effects</topic><topic>Surgery, Computer-Assisted - methods</topic><topic>Survie</topic><topic>Survival</topic><topic>Survival Analysis</topic><topic>Young Adult</topic><topic>Étendue de résection</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Napolitano, M</creatorcontrib><creatorcontrib>Vaz, G</creatorcontrib><creatorcontrib>Lawson, T.M</creatorcontrib><creatorcontrib>Docquier, M.-A</creatorcontrib><creatorcontrib>van Maanen, A</creatorcontrib><creatorcontrib>Duprez, T</creatorcontrib><creatorcontrib>Raftopoulos, C</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Neuro-chirurgie</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Napolitano, M</au><au>Vaz, G</au><au>Lawson, T.M</au><au>Docquier, M.-A</au><au>van Maanen, A</au><au>Duprez, T</au><au>Raftopoulos, C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Glioblastoma surgery with and without intraoperative MRI at 3.0T</atitle><jtitle>Neuro-chirurgie</jtitle><addtitle>Neurochirurgie</addtitle><date>2014-08-01</date><risdate>2014</risdate><volume>60</volume><issue>4</issue><spage>143</spage><epage>150</epage><pages>143-150</pages><issn>0028-3770</issn><eissn>1773-0619</eissn><coden>NUREB9</coden><abstract>Abstract Background Gross total or near total resection (GTR/NTR; resection ≥ 95%) of glioblastoma (GBM) seems correlated with a longer survival. Intraoperative MRI (ioMRI) is one method to evaluate the extent of resection (EOR) in order to improve it during the same anesthesia. We compared GBM resections using a 3.0T ioMRI and then without considering the EOR, safety, survival and discussed the indications for using this expensive modality. Methods Between March 2006 and November 2011, 56 GBM resections were performed using an ioMRI, and 38 without (control group). The only criterion in order to have access to the ioMRI was its availability. We compared the variables EOR, Karnofsky Performance Scale scores and survival in both groups. Results In the ioMRI group, 15 patients (26.8%) underwent an immediate second resection increasing the GTR rate of 10.7% and the GTR/NTR rate of 8.9%. There was a significant difference between the use of an ioMRI and the control group in reaching a larger EOR ( P = 0.049, Fisher's exact test). The effect of using the ioMRI or not on the overall survival, with EOR as covariate, was not significant ( P = 0.147, Likelihood ratio test). However, the EOR alone had a significant effect on survival ( P = 0.049, Wald test), with a shorter survival for the patients with a partial resection (PR) than a GTR/NTR (Hazard ratio = 1.6, 95% CI HR: 1.00–2.69), with a median overall survival of 15.26 months (95% CI: 12.34–19.08) for the GTR/NTR subgroup versus 10.26 months (95% CI: 6.64–15.82) for the PR subgroup. Multivariate regression analysis also identified age, sex and adjuvant chemotherapy as factors significantly associated with overall survival. Conclusions A 3.0T ioMRI improved the quality of resection by 17.8% and increased the GTR/NTR rate by 8.9% up to 73.2% without additional morbidity. A GTR/NTR improves survival duration by about 50%. Thus, it remains reasonable to increase the EOR to reach GTR/NTR using an intraoperative control. However, ioMRI should be limited to the cases for which a GTR/NTR seems preoperatively possible.</abstract><cop>Paris</cop><pub>Elsevier Masson SAS</pub><pmid>24975207</pmid><doi>10.1016/j.neuchi.2014.03.010</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Biological and medical sciences Brain Neoplasms - pathology Brain Neoplasms - surgery Combined Modality Therapy Extent of resection Female Glioblastoma Glioblastoma - pathology Glioblastoma - surgery Glioblastome High-field MRI Humans Imagerie par résonance magnétique per-opératoire Intraoperative magnetic resonance imaging IRM à champ élevé Karnofsky Performance Status Magnetic Resonance Imaging - methods Male Medical sciences Middle Aged Neoplasm, Residual - pathology Neoplasm, Residual - surgery Neurosurgery Neurosurgical Procedures - adverse effects Neurosurgical Procedures - methods Reoperation - statistics & numerical data Retrospective Studies Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery, Computer-Assisted - adverse effects Surgery, Computer-Assisted - methods Survie Survival Survival Analysis Young Adult Étendue de résection |
| title | Glioblastoma surgery with and without intraoperative MRI at 3.0T |
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