The importance of surgical resection in malignant glioma

Purpose of reviewThere is still controversy surrounding the role of cytoreductive surgery in the management of malignant gliomas because randomized studies have been missing. Here we review recent data from prospective studies that provide novel arguments in support of surgery. Recent findingsPresently available studies not only demonstrate a benefit of surgical resection of malignant gliomas compared with biopsy. Data from a randomized surgical study on a technique for identifying residual tumour intraoperatively also substantiate the beneficial role of maximal cytoreduction in patients treated by resection. Potential mechanisms appear to be linked to the removal of the therapy-resistant, hypoxic, and highly-proliferative tumour core. SummaryClinical data currently available support the use of surgery for the management of malignant glioma. Surgery improves survival and may enhance the efficacy of adjunct and adjuvant therapies.

[1]  A. Sills,et al.  Therapeutic strategies for local recurrent malignant glioma , 2004, Current treatment options in oncology.

[2]  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.

[3]  E Samset,et al.  Impact of Intraoperative MRI on the Surgical Results for High-Grade Gliomas , 2005, Minimally invasive neurosurgery : MIN.

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

[5]  R. Strausberg,et al.  Transcriptional response to hypoxia in human tumors. , 2001, Journal of the National Cancer Institute.

[6]  Timothy C Ryken,et al.  Management of malignant glioma: steady progress with multimodal approaches. , 2006, Neurosurgical focus.

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

[8]  M. McCarter,et al.  Role for Surgical Cytoreduction in Multimodality Treatments for Cancer , 2001, Annals of Surgical Oncology.

[9]  J Meixensberger,et al.  Application of Intraoperative 3D Ultrasound During Navigated Tumor Resection , 2006, Minimally invasive neurosurgery : MIN.

[10]  K. Takakura,et al.  Quantitative imaging study of extent of surgical resection and prognosis of malignant astrocytomas. , 1997, Neurosurgery.

[11]  G. Semenza,et al.  Expression of hypoxia-inducible factor 1alpha in brain tumors: association with angiogenesis, invasion, and progression. , 2000, Cancer.

[12]  T. Cascino,et al.  Response criteria for phase II studies of supratentorial malignant glioma. , 1990, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  M. Prados,et al.  Radiation response and survival time in patients with glioblastoma multiforme. , 1996, Journal of neurosurgery.

[14]  R. Mirimanoff,et al.  Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. , 2005, The New England journal of medicine.

[15]  K Sartor,et al.  Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. , 1994, Neurosurgery.

[16]  Medical Research Council.  Prognostic factors for high-grade malignant glioma: Development of a prognostic index , 2004, Journal of Neuro-Oncology.

[17]  D. Nelson,et al.  Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. , 1993, Journal of the National Cancer Institute.

[18]  G. Semenza,et al.  Expression of hypoxia‐inducible factor 1α in brain tumors , 2000 .

[19]  G. Unsgaard,et al.  Surgical Resection of High-grade Gliomas in Eloquent Regions Guided by Blood Oxygenation Level Dependent Functional Magnetic Resonance Imaging, Diffusion Tensor Tractography, and Intraoperative Navigated 3D Ultrasound , 2009, Minimally invasive neurosurgery : MIN.

[20]  Gabriele Schackert,et al.  Resection and survival in glioblastoma multiforme: an RTOG recursive partitioning analysis of ALA study patients. , 2008, Neuro-oncology.

[21]  M. Westphal,et al.  Cost of migration: invasion of malignant gliomas and implications for treatment. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[22]  Peter T. Nelson,et al.  Hypoxia Is Important in the Biology and Aggression of Human Glial Brain Tumors , 2004, Clinical Cancer Research.

[23]  O. Witte,et al.  Quantitative imaging study of extent of surgical resection and prognosis of malignant astrocytomas. , 1997, Neurosurgery.

[24]  M. Toda.  Intraoperative navigation and fluorescence imagings in malignant glioma surgery. , 2008, The Keio journal of medicine.

[25]  Veit Rohde,et al.  EXTENT OF RESECTION AND SURVIVAL IN GLIOBLASTOMA MULTIFORME: IDENTIFICATION OF AND ADJUSTMENT FOR BIAS , 2008, Neurosurgery.

[26]  Ricardo Ramina,et al.  Optimizing costs of intraoperative magnetic resonance imaging. A series of 29 glioma cases , 2009, Acta Neurochirurgica.

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

[28]  I. Whittle.  Surgery for gliomas , 2002, Current opinion in neurology.

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

[30]  F. Zanella,et al.  Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. , 2006, The Lancet. Oncology.

[31]  H Iseki,et al.  Usefulness of intraoperative magnetic resonance imaging for glioma surgery. , 2006, Acta neurochirurgica. Supplement.

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

[33]  J. Knisely,et al.  Polarographic measurements of oxygen tension in human glioma and surrounding peritumoural brain tissue. , 1999, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[34]  H Stepp,et al.  Fluorescence-guided resection of glioblastoma multiforme by using 5-aminolevulinic acid-induced porphyrins: a prospective study in 52 consecutive patients. , 2000, Journal of neurosurgery.

[35]  C. Avezaat,et al.  The influence of the extent of surgery on the neurological function and survival in malignant glioma. A retrospective analysis in 243 patients. , 1990, Journal of neurology, neurosurgery, and psychiatry.

[36]  P. Lambin,et al.  The hypoxic proteome is influenced by gene-specific changes in mRNA translation. , 2005, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[37]  P. Warnke,et al.  Surgical resection and radiation therapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme. , 1993, Journal of neurosurgery.

[38]  J. Jääskeläinen,et al.  Debulking or biopsy of malignant glioma in elderly people – a randomised study , 2003, Acta Neurochirurgica.