Beyond the margins: evaluating the necessity and timing of supramarginal resection in glioblastoma management

Abstract

Glioblastoma, classified as a grade IV astrocytoma by the World Health Organization, continues to be a very aggressive cancer that requires a comprehensive strategy comprising surgery, radiation, and chemotherapy. Traditionally, gross total resection has primarily targeted the contrast-enhanced regions shown on T1-weighted magnetic resonance images. However, current studies suggest a more aggressive approach that focuses on removing the areas around the tumor, called supramarginal resection. This innovative strategy seeks to go beyond traditional bounda-ries, offering possible advantages for survival. However, it also raises worries over the removal of brain tissue that is crucial for important functions. The extremely poor prognosis of glioblastoma, characterized by a median survival of 10 months, highlights the pressing need for novel approaches to treatment. The aim of the study is to evaluate the influence of resection with a margin that extends much beyond the contrast enhancement on the survival of certain glioblastoma patients. The potential advantages documented in previous collections of cases are consistent with the notion of personalized surgical decision-making, which questions the prevailing approach of achieving the greatest possible removal of the tumor that is enhanced by contrast. Nevertheless, the potential neurological risks should be thoroughly evaluated. The objective of this study is to provide significant insights into improving the management of glioblastoma by examining the careful trade-off between aggressive tumor removal and preserving neurological function in specific groups of patients.