Impact of Intraoperative Magnetic Resonance Imaging and Other Factors on Surgical Outcomes for Newly Diagnosed Grade II Astrocytomas and Oligodendrogliomas: A Multicenter Study.
Neurosurgery
; 88(1): 63-73, 2020 12 15.
Article
in En
| MEDLINE
| ID: mdl-32717067
ABSTRACT
BACKGROUND:
Few studies use large, multi-institutional patient cohorts to examine the role of intraoperative magnetic resonance imaging (iMRI) in the resection of grade II gliomas.OBJECTIVE:
To assess the impact of iMRI and other factors on overall survival (OS) and progression-free survival (PFS) for newly diagnosed grade II astrocytomas and oligodendrogliomas.METHODS:
Retrospective analyses of a multicenter database assessed the impact of patient-, treatment-, and tumor-related factors on OS and PFS.RESULTS:
A total of 232 resections (112 astrocytomas and 120 oligodendrogliomas) were analyzed. Oligodendrogliomas had longer OS (P < .001) and PFS (P = .01) than astrocytomas. Multivariate analyses demonstrated improved OS for gross total resection (GTR) vs subtotal resection (STR; P = .006, hazard ratio [HR] .23) and near total resection (NTR; P = .02, HR .64). GTR vs STR (P = .02, HR .54), GTR vs NTR (P = .04, HR .49), and iMRI use (P = .02, HR .54) were associated with longer PFS. Frontal (P = .048, HR 2.11) and occipital/parietal (P = .003, HR 3.59) locations were associated with shorter PFS (vs temporal). Kaplan-Meier analyses showed longer OS with increasing extent of surgical resection (EOR) (P = .03) and 1p/19q gene deletions (P = .02). PFS improved with increasing EOR (P = .01), GTR vs NTR (P = .02), and resections above STR (P = .04). Factors influencing adjuvant treatment (35.3% of patients) included age (P = .002, odds ratio [OR] 1.04) and EOR (P = .003, OR .39) but not glioma subtype or location. Additional tumor resection after iMRI was performed in 105/159 (66%) iMRI cases, yielding GTR in 54.5% of these instances.CONCLUSION:
EOR is a major determinant of OS and PFS for patients with grade II astrocytomas and oligodendrogliomas. Intraoperative MRI may improve EOR and was associated with increased PFS.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Brain Neoplasms
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Magnetic Resonance Imaging
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Neurosurgical Procedures
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Surgery, Computer-Assisted
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Glioma
Type of study:
Diagnostic_studies
/
Observational_studies
/
Risk_factors_studies
Limits:
Adolescent
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Adult
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Aged
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Child
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Child, preschool
/
Female
/
Humans
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Middle aged
Language:
En
Journal:
Neurosurgery
Year:
2020
Document type:
Article