Author:
Ius Tamara,Sabatino Giovanni,Panciani Pier Paolo,Fontanella Marco Maria,Rudà Roberta,Castellano Antonella,Barbagallo Giuseppe Maria Vincenzo,Belotti Francesco,Boccaletti Riccardo,Catapano Giuseppe,Costantino Gabriele,Della Puppa Alessandro,Di Meco Francesco,Gagliardi Filippo,Garbossa Diego,Germanò Antonino Francesco,Iacoangeli Maurizio,Mortini Pietro,Olivi Alessandro,Pessina Federico,Pignotti Fabrizio,Pinna Giampietro,Raco Antonino,Sala Francesco,Signorelli Francesco,Sarubbo Silvio,Skrap Miran,Spena Giannantonio,Somma Teresa,Sturiale Carmelo,Angileri Filippo Flavio,Esposito Vincenzo
Abstract
Abstract
Purpose
The extent of resection (EOR) is an independent prognostic factor for overall survival (OS) in adult patients with Glioma Grade 4 (GG4). The aim of the neuro-oncology section of the Italian Society of Neurosurgery (SINch®) was to provide a general overview of the current trends and technical tools to reach this goal.
Methods
A systematic review was performed. The results were divided and ordered, by an expert team of surgeons, to assess the Class of Evidence (CE) and Strength of Recommendation (SR) of perioperative drugs management, imaging, surgery, intraoperative imaging, estimation of EOR, surgery at tumor progression and surgery in elderly patients.
Results
A total of 352 studies were identified, including 299 retrospective studies and 53 reviews/meta-analysis. The use of Dexamethasone and the avoidance of prophylaxis with anti-seizure medications reached a CE I and SR A. A preoperative imaging standard protocol was defined with CE II and SR B and usefulness of an early postoperative MRI, with CE II and SR B. The EOR was defined the strongest independent risk factor for both OS and tumor recurrence with CE II and SR B. For intraoperative imaging only the use of 5-ALA reached a CE II and SR B. The estimation of EOR was established to be fundamental in planning postoperative adjuvant treatments with CE II and SR B and the stereotactic image-guided brain biopsy to be the procedure of choice when an extensive surgical resection is not feasible (CE II and SR B).
Conclusions
A growing number of evidences evidence support the role of maximal safe resection as primary OS predictor in GG4 patients. The ongoing development of intraoperative techniques for a precise real-time identification of peritumoral functional pathways enables surgeons to maximize EOR minimizing the post-operative morbidity.
Funder
Università degli Studi di Brescia
Publisher
Springer Science and Business Media LLC
Subject
Cancer Research,Neurology (clinical),Neurology,Oncology
Cited by
5 articles.
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