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Radical supra maximal resection for newly diagnosed left-sided eloquent glioblastoma...

This is a very interesting study conducted by Di et al who evaluated the safety and effectiveness of the so-called radical supramaximal resection (SMR) for glioblastoma GBM). By the way, this might be one of the most debated topics in neurosurgical oncology recently.

Extent of resection (EOR) is a well-established prognostic factor in patients with GBM, and SMR has arisen as a possible substitute for gross-total resection (GTR). The rationale is that SMR may improve progression-free survival (PFS) and overall survival (OS).

Here, the authors report a retrospective review of all patients undergoing resection of newly diagnosed left-sided eloquent GBM at their institution. SMR was defined as resection beyond abnormalities seen on T1 contrast-enhanced, with at least ≥ 40% resection of preoperative FLAIR volume.

A total of 102 patients were included in this study: 48 (47.1%) underwent SMR and 54 (52.9%) underwent GTR. On multivariate analysis, SMR was associated with both improved OS (HR 0.968, p = 0.003) and PFS (HR 0.975, p = 0.004). A final matched cohort (accounting for age, preoperative KPS, and tumor location) of 54 cases (27 SMR, 27 GTR) was created and a propensity-matched analysis was performed to compare survival outcome between GTR and SMR. The median OS for patients receiving GTR was 15.49 months compared to 21.55 months of patients receiving SMR (p = 0.0098). Furthermore, patients receiving SMR also showed significantly improved PFS at 4.51 months compared to 3.59 months in patients receiving GTR (p = 0.041).

These data reported in this retrospective study suggest that SMR, when utilized with functional mapping techniques, is a safe and feasible surrogate to traditional GTR (lesionectomy alone) for patients with eloquent GBM, with a potential survival benefit to SMR over GTR.

Iuri S. Neville is a neurological surgeon from University of Sao Paulo and 1st treasurer of Snola.

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