Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection: A report of the RANO resect group

Author:

Karschnia Philipp12ORCID,Dono Antonio3ORCID,Young Jacob S4,Juenger Stephanie T5,Teske Nico1,Häni Levin6,Sciortino Tommaso7,Mau Christine Y8,Bruno Francesco9ORCID,Nunez Luis10,Morshed Ramin A4,Haddad Alexander F4,Weller Michael11ORCID,van den Bent Martin12,Beck Juergen6,Hervey-Jumper Shawn4,Molinaro Annette M4ORCID,Tandon Nitin3ORCID,Rudà Roberta9,Vogelbaum Michael A8,Bello Lorenzo7,Schnell Oliver6,Grau Stefan J513,Chang Susan M4,Berger Mitchel S4ORCID,Esquenazi Yoshua3ORCID,Tonn Joerg-Christian12

Affiliation:

1. Department of Neurosurgery, Ludwig-Maximilians-University , Munich , Germany

2. German Cancer Consortium (DKTK) , Partner Site Munich , Germany

3. Department of Neurosurgery, McGovern Medical School at UT Health Houston , Houston, Texas , USA

4. Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco , San Francisco, California , USA

5. Department of Neurosurgery, University of Cologne , Cologne , Germany

6. Department of Neurosurgery, University of Freiburg , Freiburg , Germany

7. Division of Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan , Milan , Italy

8. Department of Neuro-Oncology, Moffitt Cancer Center , Tampa, Florida , USA

9. Division of Neuro-Oncology, Department of Neuroscience, University of Turin , Italy

10. Department of Diagnostic and Interventional Imaging, McGovern Medical School at UT Health Houston , Houston, Texas , USA

11. Department of Neurology, University Hospital and University of Zurich , Zurich , Switzerland

12. Department of Neurology, Erasmus MC Cancer Institute , Rotterdam , The Netherlands

13. Klinikum Fulda, Academic Hospital of Marburg University , Klinikum, Fulda , Germany

Abstract

Abstract Background The value of re-resection in recurrent glioblastoma remains controversial as a randomized trial that specifies intentional incomplete resection cannot be justified ethically. Here, we aimed to (1) explore the prognostic role of extent of re-resection using the previously proposed Response Assessment in Neuro-Oncology (RANO) classification (based upon residual contrast-enhancing (CE) and non-CE tumor), and to (2) define factors consolidating the surgical effects on outcome. Methods The RANO resect group retrospectively compiled an 8-center cohort of patients with first recurrence from previously resected glioblastomas. The associations of re-resection and other clinical factors with outcome were analyzed. Propensity score-matched analyses were constructed to minimize confounding effects when comparing the different RANO classes. Results We studied 681 patients with first recurrence of Isocitrate Dehydrogenase (IDH) wild-type glioblastomas, including 310 patients who underwent re-resection. Re-resection was associated with prolonged survival even when stratifying for molecular and clinical confounders on multivariate analysis; ≤1 cm3 residual CE tumor was associated with longer survival than non-surgical management. Accordingly, “maximal resection” (class 2) had superior survival compared to “submaximal resection” (class 3). Administration of (radio-)chemotherapy in the absence of postoperative deficits augmented the survival associations of smaller residual CE tumors. Conversely, “supramaximal resection” of non-CE tumor (class 1) was not associated with prolonged survival but was frequently accompanied by postoperative deficits. The prognostic role of residual CE tumor was confirmed in propensity score analyses. Conclusions The RANO resect classification serves to stratify patients with re-resection of glioblastoma. Complete resection according to RANO resect classes 1 and 2 is prognostic.

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Neurology (clinical),Oncology

Reference33 articles.

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2. Glioblastoma in adults: A Society for Neuro-Oncology (SNO) and European Society of Neuro-Oncology (EANO) consensus review on current management and future directions;Wen;Neuro Oncol,2020

3. New prognostic factors and calculators for outcome prediction in patients with recurrent glioblastoma: A pooled analysis of EORTC Brain Tumour Group phase I and II clinical trials;Gorlia;Eur J Cancer.,2012

4. NRG oncology/RTOG1205: A randomized phase II trial of concurrent bevacizumab and reirradiation versus bevacizumab alone as treatment for recurrent glioblastoma;Tsien;J Clin Oncol.,2022

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