A Crowdsourced Consensus on Supratotal Resection Versus Gross Total Resection for Anatomically Distinct Primary Glioblastoma,Neurosurgery

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A Crowdsourced Consensus on Supratotal Resection Versus Gross Total Resection for Anatomically Distinct Primary Glioblastoma
Neurosurgery ( IF 3.9 ) Pub Date : 2021-07-28 , DOI: 10.1093/neuros/nyab257
Adham M Khalafallah ₁ , Maureen Rakovec ₁ , Chetan Bettegowda ₁ , Christopher M Jackson ₁ , Gary L Gallia ₁ , Jon D Weingart ₁ , Michael Lim ₂ , Yoshua Esquenazi ₃ , Brad E Zacharia ₄ , Ezequiel Goldschmidt ₅ , Mateo Ziu ₆ , Michael E Ivan ₇ , Andrew S Venteicher ₈ , Edjah K Nduom ₉ , Adam N Mamelak ₁₀ , Ray M Chu ₁₀ , John S Yu ₁₀ , Jason P Sheehan ₁₁ , Brian V Nahed ₁₂ , Bob S Carter ₁₂ , Mitchel S Berger ₁₃ , Raymond Sawaya ₁₄ , Debraj Mukherjee _{1,

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Affiliation

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas, USA.
Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Inova Neuroscience and Spine Institute, University of Virginia Medical School-Inova Campus, Falls Church, Virginia, USA.
Sylvester Comprehensive Cancer Center, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, Maryland, USA.
Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Division of Surgery, Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Abstract

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.

中文翻译：

解剖上不同的原发性胶质母细胞瘤的全切除与全切除的众包共识

摘要

背景

对比增强肿瘤的总切除 (GTR) 与原发性胶质母细胞瘤的存活率增加有关。最近，对胶质母细胞瘤进行全切除术 (SpTRs) 的兴趣越来越大。

客观的

为了解决已发表的结果，部分原因是由于对 SpTR 的定义和适当使用缺乏共识。

方法

众包方法用于调查代表全国 14 个卫生系统的 21 名神经外科肿瘤学家。参与者被提出了 11 个 SpTR 的定义，并要求他们对每个定义的适当性进行评分。参与者回顾了 22 个解剖学上不同的胶质母细胞瘤的 T1 加权增强后和流体衰减反转恢复磁共振成像。参与者被要求评估肿瘤位置的口才，在一项比较总总量与 SpTR 的随机试验中招募患者的感知平衡，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 加上一些非对比增强的切除是 SpTR 的适当定义。总体而言，在口才、平衡和个人治疗计划方面存在适度的评分者间一致性。在过去一年中对胶质母细胞瘤进行了超过 10 次 SpTR 的 4 位神经外科医生更有可能将其推荐为他们的治疗计划 ( P < .005)。根据感知的口才将病例分为 3 个解剖学上不同的组。前颞叶和右额叶胶质母细胞瘤被认为是最佳的随机化候选者。

结论

我们为胶质母细胞瘤的 SpTR 建立了共识定义，并确定了被认为最适合 SpTR 的解剖学上不同的位置。这些结果可用于计划前瞻性试验，调查 SpTR 对胶质母细胞瘤的潜在临床效用。

更新日期：2021-09-15

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