The role of surgery in high-grade glioma--is surgical resection justified? A review of the current knowledge.

INTRODUCTION The aims of this article were to review the role of surgical resection in the management of high-grade gliomas and to determine whether there is any survival benefit from surgical resection. METHODS A literature review of the influence of surgical resection on outcome was carried out. Relevant original and review papers were obtained through a PubMed search using the following keywords: glioma, resection, prognosis and outcome. RESULTS Presently, there is a lack of evidence to support a survival benefit with aggressive glioma resection, but this should not detract patients from undergoing surgery as there are many other clinical benefits of glioma excision. In addition, limiting surgical morbidity through the use of adjuvant techniques such as intraoperative magnetic resonance imaging (MRI), functional MRI and awake craniotomy is becoming increasingly important. CONCLUSIONS Ideally, a randomised controlled trial would be the best way to resolve the issue of whether (and to what extent) surgical resection leads to improvements in patient outcome and survival, but this would not be ethical. The second best option would be well-controlled retrospective studies with a multivariate analysis of all potential confounding factors.

[1]  S. Brem,et al.  Survival rates in patients with primary malignant brain tumors stratified by patient age and tumor histological type: an analysis based on Surveillance, Epidemiology, and End Results (SEER) data, 1973-1991. , 1998, Journal of neurosurgery.

[2]  R. Arusell,et al.  A Prospective Study of Quality of Life in Adults with Newly Diagnosed High-grade Gliomas: The Impact of the Extent of Resection on Quality of Life and Survival , 2005, Neurosurgery.

[3]  T. Hammeke,et al.  Functional magnetic resonance imaging mapping of the motor cortex in patients with cerebral tumors. , 1996, Neurosurgery.

[4]  F. Lang,et al.  Current Surgical Management of Glioblastoma , 2003, Cancer journal.

[5]  Peter M Black,et al.  A low-field intraoperative MRI system for glioma surgery: is it worthwhile? , 2005, Neurosurgery clinics of North America.

[6]  J. Rich,et al.  New treatment strategies for malignant gliomas , 2006, Expert review of anticancer therapy.

[7]  S. N. Rowe.  MENTAL CHANGES FOLLOWING THE REMOVAL OF THE RIGHT CEREBRAL HEMISPHERE FOR BRAIN TUMOR , 1937 .

[8]  Raymond Sawaya,et al.  Extent of Resection in Malignant Gliomas: a Critical Summary , 2004, Journal of Neuro-Oncology.

[9]  W. Powlis,et al.  Does extent of surgery influence outcome for astrocytoma with atypical or anaplastic foci (AAF)? A report from three Radiation Therapy Oncology Group (RTOG) trials , 1992, Journal of Neuro-Oncology.

[10]  Christos Trantakis,et al.  Intraoperative MRI to guide the resection of primary supratentorial glioblastoma multiforme—a quantitative radiological analysis , 2005, Neuroradiology.

[11]  F. B. Mallory.  The principles of pathologic histology , 2009 .

[12]  Martin J. van den Bent,et al.  Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. , 2005, The New England journal of medicine.

[13]  I. Whittle,et al.  Effects of resective surgery for left-sided intracranial tumours on language function: a prospective study , 1998, The Lancet.

[14]  I. Ciric,et al.  Neurosurgical Outcomes in a Modern Series of 400 Craniotomies for Treatment of Parenchymal Tumors , 1998 .

[15]  Alexander Muacevic,et al.  Quality-adjusted survival after tumor resection and/or radiation therapy for elderly patients with glioblastoma multiforme , 2003, Journal of Neurology.

[16]  H. Mehdorn,et al.  Glioblastoma multiforme-report of 267 cases treated at a single institution. , 2005, Surgical neurology.

[17]  Z L Gokaslan,et al.  A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. , 2001, Journal of neurosurgery.

[18]  M. Hart,et al.  Biopsy versus resection for high-grade glioma. , 2000, The Cochrane database of systematic reviews.

[19]  Z L Gokaslan,et al.  Limitations of stereotactic biopsy in the initial management of gliomas. , 2001, Neuro-oncology.

[20]  W. Gardner.  REMOVAL OF THE RIGHT CEREBRAL HEMISPHERE FOR INFILTRATING GLIOMA: REPORT OF A CASE , 1933 .

[21]  L. Stewart,et al.  Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials , 2002, The Lancet.

[22]  M. Mikhael,et al.  Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. , 1987, Neurosurgery.

[23]  Patrick Mitchell,et al.  Surgery for malignant gliomas: mechanistic reasoning and slippery statistics , 2005, The Lancet Neurology.

[24]  Christopher Nimsky,et al.  Intraoperative visualization for resection of gliomas: the role of functional neuronavigation and intraoperative 1.5 T MRI , 2006, Neurological research.

[25]  J. Maroon,et al.  The relationship between survival and the extent of the resection in patients with supratentorial malignant gliomas. , 1991, Neurosurgery.

[26]  W. Dandy,et al.  REMOVAL OF RIGHT CEREBRAL HEMISPHERE FOR CERTAIN TUMORS WITH HEMIPLEGIA: PRELIMINARY REPORT , 1928 .

[27]  C. Burklund,et al.  Language and the cerebral hemispheres , 1977, Neurology.

[28]  Alexander Brawanski,et al.  Level of evidence in the literature concerning brain tumor resection , 2004, Clinical Neurology and Neurosurgery.

[29]  M. Prados,et al.  Patterns of recurrence of glioblastoma multiforme after external irradiation followed by implant boost. , 1994, International journal of radiation oncology, biology, physics.

[30]  J. Nazzaro,et al.  The role of surgery in the management of supratentorial intermediate and high-grade astrocytomas in adults. , 1990, Journal of neurosurgery.

[31]  R. Grant,et al.  Biopsy versus resection for malignant glioma. , 2001, The Cochrane database of systematic reviews.

[32]  R. Godlee,et al.  HOSPITAL FOR EPILEPSY AND PARALYSIS, REGENT'S PARK.: EXCISION OF A TUMOUR FROM THE BRAIN , 1884 .

[33]  Hui-Kuo G Shu,et al.  Near complete surgical resection predicts a favorable outcome in pediatric patients with nonbrainstem, malignant gliomas , 2004, Cancer.

[34]  Reto Meuli,et al.  Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[35]  B A Kall,et al.  Stereotactic histologic correlations of computed tomography- and magnetic resonance imaging-defined abnormalities in patients with glial neoplasms. , 1987, Mayo Clinic proceedings.

[36]  Jan C Buckner,et al.  Factors influencing survival in high-grade gliomas. , 2003, Seminars in oncology.

[37]  W. F. Hillier.  Total Left Cerebral Hemispherectomy for Malignant Glioma , 1954, Neurology.

[38]  Anthony Asher,et al.  Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project. , 2003, Journal of neurosurgery.

[39]  B. O'neill,et al.  Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain. , 2001, Mayo Clinic proceedings.

[40]  Kenneth R. Hess,et al.  Extent of Resection as a Prognostic Variable in the Treatment of Gliomas , 1999, Journal of Neuro-Oncology.