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Surgical treatment of supratentorial high-grade glioma:

what is the best strategy?

The fruit of seven years’ experience

S. SIMPATICO, P. CAIAZZO, A. DE BELLIS, D. SIMPATICO*, M. DE BELLIS

UOSC di Neurochirurgia, Ospedale “S. Maria”, Loreto Mare (Napoli), Italy

* Istituto di Biologia Molecolare, Università degli Studi, Napoli, Italy

 

 

 

 

Summary

 

 

 

 

 

 

Progress in Neuroscience 2013; 1 (1-4): 105-110.

doi: 10.14588/PiN.2013.Simpatico.105

 

 

 

 

 

 

AIM. Patients with high-grade gliomas (grade IV gliomas and glioblastomas) have a median survival of approximately 12 months, a rate that has not substantially improved over the years, despite advances in medicine and surgery. It is therefore vital to elucidate the effects of surgery on the quality of life of patients harbouring high-grade glioma, identifying factors associated with prolonged and reduced functional outcome with a view to guiding treatment strategies and prolonging functional independence. For this reason we set out to review the data pertaining to the patients surgically treated for high-grade glioma over the last seven years. 

MATERIALS AND METHODS. 156 patients (90 men and 66 women) of average age 66.6 years (range 26-79 years) with high-grade glioma have been surgically treated by our team over the last seven years (2006-2012). The aim of surgery was generally gross total removal. Subtotal resection was performed primarily when the tumour involved the eloquent brain, as confirmed by intraoperative mapping and/or monitoring. Stereotactic biopsy was performed for inoperable tumours. Resections were retrospectively classified as either gross total removal or subtotal resection by an independent neuroradiologist comparing pre- and post-operative contrast CT/MR scans, and pre-surgical Karnofsky performance status scores were compared with those at 6- and 12-month follow-up.

RESULTS. Gross total removal was achieved in 80 out of the 156 cases (51%), subtotal resection (more than 10% residual mass detected) in 43 patients (28%), and stereotactic biopsy was performed in 33 patients (21%). There were 5 cases of perioperative death (3%), and 27 patients (17%) developed new or increased motor, visual, or language deficit. 90 patients then underwent conventional radiotherapy. Local chemotherapy was administered in five cases via carmustine wafers. Oral chemotherapy with temozolomide was administered to 69 patients, of whom 45 (65%) received radiotherapy and temozolomide according to the protocol used in the study of Stupp et al. (N Engl J Med, 2005). 38 young patients (< 55 years), treated only with gross removal surgery, survived 12 months on average. 22 young patients with multimodal treatment (surgery, radiotherapy and temozolomide) survived 18 months on average. 53/156 patients fell into the older age category (above 55 years), and were treated with surgery, chemo-irradiation and the adjuvant temozolomide. Their survival was significantly lower than that of younger patients, at an average of 11 months 

CONCLUSION. Survival prospects for patients with glioblastoma remain very poor, which makes it important to understand the effects that surgery has on quality of life and, more specifically, functional independence for patients with high-grade glioma. Indeed, although several early-phase clinical trials of targeted therapies in high-grade glioma have been completed or are underway, either singly or in combination with standard chemotherapy and/or radiation therapy, surgery remains the primary intervention at the present time.

KEY WORDS: High-grade glioma, Multidisciplinary approach, Quality of life, Surgical treatment.

 

 

 

 

 

 

 

 

 


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 Progress in Neuroscience - ISSN 2240-5135 - Copyright  © 2011-2015 SNO & new MAGAZINE s.r.l. - Italy