Establishing percent resection and residual volume thresholds affecting survival and recurrence for patients with newly diagnosed intracranial glioblastoma

Kaisorn L. Chaichana, Ignacio Jusue-Torres, Rodrigo Navarro-Ramirez, Shaan M. Raza, Maria Pascual-Gallego, Aly Ibrahim, Marta Hernandez-Hermann, Luis Gomez, Xiaobu Ye, Jon D. Weingart, Alessandro Olivi, Jaishri Blakeley, Gary L. Gallia, Michael Lim, Henry Brem, Alfredo Quinones-Hinojosa

Research output: Contribution to journalArticle

181 Citations (Scopus)

Abstract

IntroductionSurgery is first-line therapy for glioblastoma, and there is evidence that gross total resection is associated with improved survival. Gross total resection, however, is not always possible, and relationships among extent (percent) of resection (EOR), residual volume (RV), and survival are unknown. The goals were to evaluate whether there is an association between EOR and RV with survival and recurrence and to establish minimum EOR and maximum RV thresholds.MethodsAdult patients who underwent primary glioblastoma surgery from 2007 to 2011 were retrospectively reviewed. Three-dimensional volumetric tumor measurements were made. Multivariate proportional hazards regression analysis was used to evaluate the relationship between EOR and RV with survival and recurrence.ResultsOf 259 patients, 203 (78%) died and 156 (60%) had tumor recurrence. The median survival and progression-free survival were 13.4 and 8.9 months, respectively. The median (interquartile range) pre- and postoperative tumor volumes were 32.2 (14.0-56.3) and 2.1 (0.0-7.9) cm3, respectively. EOR was independently associated with survival (hazard ratio [HR], 0.995; 95% confidence interval [CI]: 0.990-0.998; P =. 008) and recurrence (HR [95% CI], 0.992 [0.983-0.998], P =. 005). The minimum EOR threshold for survival (P =. 0006) and recurrence (P =. 005) was 70%. RV was also associated with survival (HR [95% CI], 1.019 [1.006-1.030], P =. 004) and recurrence (HR [95% CI], 1.024 [1.001-1.044], P =. 03). The maximum RV threshold for survival (P =. 01) and recurrence (P =. 01) was 5 cm3.ConclusionThis study shows for the first time that both EOR and RV are significantly associated with survival and recurrence, where the thresholds are 70% and 5 cm3, respectively. These findings may help guide surgical and adjuvant therapies aimed at optimizing outcomes for glioblastoma patients.

Original languageEnglish (US)
Pages (from-to)113-122
Number of pages10
JournalNeuro-Oncology
Volume16
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

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Residual Volume
Glioblastoma
Recurrence
Survival
Confidence Intervals
Tumor Burden
Disease-Free Survival
Neoplasms
Regression Analysis

Keywords

  • extent of resection
  • GBM
  • glioblastoma
  • residual
  • surgery
  • survival
  • volumetric

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Clinical Neurology
  • Medicine(all)

Cite this

Chaichana, K. L., Jusue-Torres, I., Navarro-Ramirez, R., Raza, S. M., Pascual-Gallego, M., Ibrahim, A., ... Quinones-Hinojosa, A. (2014). Establishing percent resection and residual volume thresholds affecting survival and recurrence for patients with newly diagnosed intracranial glioblastoma. Neuro-Oncology, 16(1), 113-122. https://doi.org/10.1093/neuonc/not137

Establishing percent resection and residual volume thresholds affecting survival and recurrence for patients with newly diagnosed intracranial glioblastoma. / Chaichana, Kaisorn L.; Jusue-Torres, Ignacio; Navarro-Ramirez, Rodrigo; Raza, Shaan M.; Pascual-Gallego, Maria; Ibrahim, Aly; Hernandez-Hermann, Marta; Gomez, Luis; Ye, Xiaobu; Weingart, Jon D.; Olivi, Alessandro; Blakeley, Jaishri; Gallia, Gary L.; Lim, Michael; Brem, Henry; Quinones-Hinojosa, Alfredo.

In: Neuro-Oncology, Vol. 16, No. 1, 2014, p. 113-122.

Research output: Contribution to journalArticle

Chaichana, KL, Jusue-Torres, I, Navarro-Ramirez, R, Raza, SM, Pascual-Gallego, M, Ibrahim, A, Hernandez-Hermann, M, Gomez, L, Ye, X, Weingart, JD, Olivi, A, Blakeley, J, Gallia, GL, Lim, M, Brem, H & Quinones-Hinojosa, A 2014, 'Establishing percent resection and residual volume thresholds affecting survival and recurrence for patients with newly diagnosed intracranial glioblastoma', Neuro-Oncology, vol. 16, no. 1, pp. 113-122. https://doi.org/10.1093/neuonc/not137
Chaichana, Kaisorn L. ; Jusue-Torres, Ignacio ; Navarro-Ramirez, Rodrigo ; Raza, Shaan M. ; Pascual-Gallego, Maria ; Ibrahim, Aly ; Hernandez-Hermann, Marta ; Gomez, Luis ; Ye, Xiaobu ; Weingart, Jon D. ; Olivi, Alessandro ; Blakeley, Jaishri ; Gallia, Gary L. ; Lim, Michael ; Brem, Henry ; Quinones-Hinojosa, Alfredo. / Establishing percent resection and residual volume thresholds affecting survival and recurrence for patients with newly diagnosed intracranial glioblastoma. In: Neuro-Oncology. 2014 ; Vol. 16, No. 1. pp. 113-122.
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abstract = "IntroductionSurgery is first-line therapy for glioblastoma, and there is evidence that gross total resection is associated with improved survival. Gross total resection, however, is not always possible, and relationships among extent (percent) of resection (EOR), residual volume (RV), and survival are unknown. The goals were to evaluate whether there is an association between EOR and RV with survival and recurrence and to establish minimum EOR and maximum RV thresholds.MethodsAdult patients who underwent primary glioblastoma surgery from 2007 to 2011 were retrospectively reviewed. Three-dimensional volumetric tumor measurements were made. Multivariate proportional hazards regression analysis was used to evaluate the relationship between EOR and RV with survival and recurrence.ResultsOf 259 patients, 203 (78{\%}) died and 156 (60{\%}) had tumor recurrence. The median survival and progression-free survival were 13.4 and 8.9 months, respectively. The median (interquartile range) pre- and postoperative tumor volumes were 32.2 (14.0-56.3) and 2.1 (0.0-7.9) cm3, respectively. EOR was independently associated with survival (hazard ratio [HR], 0.995; 95{\%} confidence interval [CI]: 0.990-0.998; P =. 008) and recurrence (HR [95{\%} CI], 0.992 [0.983-0.998], P =. 005). The minimum EOR threshold for survival (P =. 0006) and recurrence (P =. 005) was 70{\%}. RV was also associated with survival (HR [95{\%} CI], 1.019 [1.006-1.030], P =. 004) and recurrence (HR [95{\%} CI], 1.024 [1.001-1.044], P =. 03). The maximum RV threshold for survival (P =. 01) and recurrence (P =. 01) was 5 cm3.ConclusionThis study shows for the first time that both EOR and RV are significantly associated with survival and recurrence, where the thresholds are 70{\%} and 5 cm3, respectively. These findings may help guide surgical and adjuvant therapies aimed at optimizing outcomes for glioblastoma patients.",
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T1 - Establishing percent resection and residual volume thresholds affecting survival and recurrence for patients with newly diagnosed intracranial glioblastoma

AU - Chaichana, Kaisorn L.

AU - Jusue-Torres, Ignacio

AU - Navarro-Ramirez, Rodrigo

AU - Raza, Shaan M.

AU - Pascual-Gallego, Maria

AU - Ibrahim, Aly

AU - Hernandez-Hermann, Marta

AU - Gomez, Luis

AU - Ye, Xiaobu

AU - Weingart, Jon D.

AU - Olivi, Alessandro

AU - Blakeley, Jaishri

AU - Gallia, Gary L.

AU - Lim, Michael

AU - Brem, Henry

AU - Quinones-Hinojosa, Alfredo

PY - 2014

Y1 - 2014

N2 - IntroductionSurgery is first-line therapy for glioblastoma, and there is evidence that gross total resection is associated with improved survival. Gross total resection, however, is not always possible, and relationships among extent (percent) of resection (EOR), residual volume (RV), and survival are unknown. The goals were to evaluate whether there is an association between EOR and RV with survival and recurrence and to establish minimum EOR and maximum RV thresholds.MethodsAdult patients who underwent primary glioblastoma surgery from 2007 to 2011 were retrospectively reviewed. Three-dimensional volumetric tumor measurements were made. Multivariate proportional hazards regression analysis was used to evaluate the relationship between EOR and RV with survival and recurrence.ResultsOf 259 patients, 203 (78%) died and 156 (60%) had tumor recurrence. The median survival and progression-free survival were 13.4 and 8.9 months, respectively. The median (interquartile range) pre- and postoperative tumor volumes were 32.2 (14.0-56.3) and 2.1 (0.0-7.9) cm3, respectively. EOR was independently associated with survival (hazard ratio [HR], 0.995; 95% confidence interval [CI]: 0.990-0.998; P =. 008) and recurrence (HR [95% CI], 0.992 [0.983-0.998], P =. 005). The minimum EOR threshold for survival (P =. 0006) and recurrence (P =. 005) was 70%. RV was also associated with survival (HR [95% CI], 1.019 [1.006-1.030], P =. 004) and recurrence (HR [95% CI], 1.024 [1.001-1.044], P =. 03). The maximum RV threshold for survival (P =. 01) and recurrence (P =. 01) was 5 cm3.ConclusionThis study shows for the first time that both EOR and RV are significantly associated with survival and recurrence, where the thresholds are 70% and 5 cm3, respectively. These findings may help guide surgical and adjuvant therapies aimed at optimizing outcomes for glioblastoma patients.

AB - IntroductionSurgery is first-line therapy for glioblastoma, and there is evidence that gross total resection is associated with improved survival. Gross total resection, however, is not always possible, and relationships among extent (percent) of resection (EOR), residual volume (RV), and survival are unknown. The goals were to evaluate whether there is an association between EOR and RV with survival and recurrence and to establish minimum EOR and maximum RV thresholds.MethodsAdult patients who underwent primary glioblastoma surgery from 2007 to 2011 were retrospectively reviewed. Three-dimensional volumetric tumor measurements were made. Multivariate proportional hazards regression analysis was used to evaluate the relationship between EOR and RV with survival and recurrence.ResultsOf 259 patients, 203 (78%) died and 156 (60%) had tumor recurrence. The median survival and progression-free survival were 13.4 and 8.9 months, respectively. The median (interquartile range) pre- and postoperative tumor volumes were 32.2 (14.0-56.3) and 2.1 (0.0-7.9) cm3, respectively. EOR was independently associated with survival (hazard ratio [HR], 0.995; 95% confidence interval [CI]: 0.990-0.998; P =. 008) and recurrence (HR [95% CI], 0.992 [0.983-0.998], P =. 005). The minimum EOR threshold for survival (P =. 0006) and recurrence (P =. 005) was 70%. RV was also associated with survival (HR [95% CI], 1.019 [1.006-1.030], P =. 004) and recurrence (HR [95% CI], 1.024 [1.001-1.044], P =. 03). The maximum RV threshold for survival (P =. 01) and recurrence (P =. 01) was 5 cm3.ConclusionThis study shows for the first time that both EOR and RV are significantly associated with survival and recurrence, where the thresholds are 70% and 5 cm3, respectively. These findings may help guide surgical and adjuvant therapies aimed at optimizing outcomes for glioblastoma patients.

KW - extent of resection

KW - GBM

KW - glioblastoma

KW - residual

KW - surgery

KW - survival

KW - volumetric

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DO - 10.1093/neuonc/not137

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