Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Neurosurgery. 2021 Sep 15;89(4):712-719. doi: 10.1093/neuros/nyab257.
BACKGROUND: Gross total resection (GTR) of contrast-enhancing tumor is associated with increased survival in primary glioblastoma. Recently, there has been increasing interest in performing supratotal resections (SpTRs) for glioblastoma. OBJECTIVE: To address the published results, which have varied in part due to lack of consensus on the definition and appropriate use of SpTR. METHODS: A crowdsourcing approach was used to survey 21 neurosurgical oncologists representing 14 health systems nationwide. Participants were presented with 11 definitions of SpTR and asked to rate the appropriateness of each definition. Participants reviewed T1-weighed postcontrast and fluid-attenuated inversion-recovery magnetic resonance imaging for 22 anatomically distinct glioblastomas. Participants were asked to assess the tumor location's eloquence, the perceived equipoise of enrolling patients in a randomized trial comparing gross total to SpTR, and their personal treatment plans. RESULTS: Most neurosurgeons surveyed (n = 18, 85.7%) agree that GTR plus resection of some noncontrast enhancement is an appropriate definition for SpTR. Overall, moderate inter-rater agreement existed regarding eloquence, equipoise, and personal treatment plans. The 4 neurosurgeons who had performed >10 SpTRs for glioblastomas in the past year were more likely to recommend it as their treatment plan (P < .005). Cases were divided into 3 anatomically distinct groups based upon perceived eloquence. Anterior temporal and right frontal glioblastomas were considered the best randomization candidates. CONCLUSION: We established a consensus definition for SpTR of glioblastoma and identified anatomically distinct locations deemed most amenable to SpTR. These results may be used to plan prospective trials investigating the potential clinical utility of SpTR for glioblastoma.
背景:在原发性胶质母细胞瘤中,增强肿瘤的全切除(GTR)与生存时间延长相关。最近,对于胶质母细胞瘤施行近全切除(SpTR)的兴趣日益增加。
目的:针对发表的结果,由于缺乏对 SpTR 的定义和适当使用的共识,部分结果存在差异。
方法:采用众包方法调查了全国 14 个医疗系统的 21 名神经外科肿瘤医生。参与者被提供了 11 种 SpTR 的定义,并被要求对每种定义的适当性进行评分。参与者对 22 个解剖上不同的胶质母细胞瘤进行 T1 加权增强后和液体衰减反转恢复磁共振成像检查。参与者被要求评估肿瘤位置的重要性、对将患者纳入 GTR 与 SpTR 比较的随机试验的平衡看法,以及他们的个人治疗计划。
结果:大多数接受调查的神经外科医生(n=18,85.7%)同意 GTR 加切除部分非增强区是 SpTR 的适当定义。总的来说,关于重要性、平衡和个人治疗计划,存在中度的观察者间一致性。过去一年中进行了 >10 例 SpTR 治疗胶质母细胞瘤的 4 名神经外科医生更倾向于将其作为他们的治疗计划(P<.005)。根据感知的重要性,将病例分为 3 个解剖上不同的组。前颞叶和右额叶胶质母细胞瘤被认为是最适合随机分组的病例。
结论:我们建立了胶质母细胞瘤 SpTR 的共识定义,并确定了认为最适合 SpTR 的解剖上不同的部位。这些结果可用于计划研究 SpTR 治疗胶质母细胞瘤的潜在临床应用的前瞻性试验。
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