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Journal of Neuro-Oncology

, Volume 145, Issue 1, pp 143–150 | Cite as

Surgery for temporal glioblastoma: lobectomy outranks oncosurgical-based gross-total resection

  • Matthias SchneiderEmail author
  • Anna-Laura Potthoff
  • Vera C. Keil
  • Ági Güresir
  • Johannes Weller
  • Valeri Borger
  • Motaz Hamed
  • Andreas Waha
  • Hartmut Vatter
  • Erdem Güresir
  • Ulrich Herrlinger
  • Patrick Schuss
Clinical Study

Abstract

Objective

Supra-total glioblastoma resection has gained growing attention with regard to superior long-term disease control. However, aggressive onco-surgical approaches—geared beyond conventional gross total resections (GTR)—are limited by the impairment of adjacent eloquent areas at risk that may entail severe postoperative functional morbidity. Against this backdrop we analyzed our institutional database with regard to potential survival benefits of anterior temporal lobectomy as a paradigm for supra-total resection in patients with precisely temporal-located, non-eloquent glioblastoma.

Methods

Between 2012 and 2017, 38 patients with isolated temporal glioblastoma underwent GTR or temporal lobectomy at the authors’ institution. Both groups of differing resection modalities were compared with regard to postoperative Karnofsky performance score (KPS), progression-free survival (PFS), and overall survival (OS).

Results

Patients with temporal lobectomy exhibited significantly superior median KPS at the 12 months follow-up compared to the GTR group (median KPS of 80 vs. 60, p = 0.04). Temporal lobectomy was associated with significantly prolonged PFS (p = 0.005) and OS (p = 0.002) coming up to 15 months (95% CI 9.7–22.1) and 23 months (95% CI 14.8–34.5) compared to 7 months (95% CI 3.3–8.3) and 11 months (95% CI 9.2–17.9) for the GTR group. Multivariate analysis revealed temporal lobectomy as the only predictor for both superior PFS (p = 0.037, OR 7.3, 95% CI 1.1–47.4) and OS (p = 0.04, OR 7.8, 95% CI 1.1–55.2).

Conclusions

These results strongly suggest temporal lobectomy as an aggressive supra-total resection policy to constitute the surgical modality of choice for isolated temporal-located glioblastoma.

Keywords

Glioblastoma Lobectomy Gross-total resection Overall survival 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest

Ethical approval

The present study was approved by the local ethics committee af the University of Bonn.

Informed consent

Informed consent was not sought as a retrospective design was used.

References

  1. 1.
    Preusser M, de Ribaupierre S, Wohrer A, Erridge SC, Hegi M, Weller M, Stupp R (2011) Current concepts and management of glioblastoma. Ann Neurol 70(1):9–21.  https://doi.org/10.1002/ana.22425 CrossRefPubMedGoogle Scholar
  2. 2.
    Cai X, Sughrue ME (2018) Glioblastoma: new therapeutic strategies to address cellular and genomic complexity. Oncotarget 9(10):9540–9554.  https://doi.org/10.18632/oncotarget.23476 CrossRefPubMedGoogle Scholar
  3. 3.
    Potthoff AL, Heiland DH, Evert BO, Almeida FR, Behringer SP, Dolf A, Güresir A, Güresir E, Joseph K, Pietsch T, Schuss P, Herrlinger U, Westhoff MA, Vatter H, Waha A, Schneider M (2019) Inhibition of gap junctions sensitizes primary glioblastoma cells for temozolomide. Cancers.  https://doi.org/10.3390/cancers11060858 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Pyonteck SM, Akkari L, Schuhmacher AJ, Bowman RL, Sevenich L, Quail DF, Olson OC, Quick ML, Huse JT, Teijeiro V, Setty M, Leslie CS, Oei Y, Pedraza A, Zhang J, Brennan CW, Sutton JC, Holland EC, Daniel D, Joyce JA (2013) CSF-1R inhibition alters macrophage polarization and blocks glioma progression. Nat Med 19(10):1264–1272.  https://doi.org/10.1038/nm.3337 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Stummer W, Reulen HJ, Meinel T, Pichlmeier U, Schumacher W, Tonn JC, Rohde V, Oppel F, Turowski B, Woiciechowsky C, Franz K, Pietsch T, Group AL-GS (2008) Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery 62(3):564–576.  https://doi.org/10.1227/01.neu.0000317304.31579.17 discussion 564-576 CrossRefPubMedGoogle Scholar
  6. 6.
    McGirt MJ, Chaichana KL, Gathinji M, Attenello FJ, Than K, Olivi A, Weingart JD, Brem H, Quinones-Hinojosa AR (2009) Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg 110(1):156–162.  https://doi.org/10.3171/2008.4.17536 CrossRefPubMedGoogle Scholar
  7. 7.
    Brown TJ, Brennan MC, Li M, Church EW, Brandmeir NJ, Rakszawski KL, Patel AS, Rizk EB, Suki D, Sawaya R, Glantz M (2016) Association of the extent of resection with survival in glioblastoma: a systematic review and meta-analysis. JAMA Oncol 2(11):1460–1469.  https://doi.org/10.1001/jamaoncol.2016.1373 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Yan JL, van der Hoorn A, Larkin TJ, Boonzaier NR, Matys T, Price SJ (2017) Extent of resection of peritumoral diffusion tensor imaging-detected abnormality as a predictor of survival in adult glioblastoma patients. J Neurosurg 126(1):234–241.  https://doi.org/10.3171/2016.1.JNS152153 CrossRefPubMedGoogle Scholar
  9. 9.
    Sanai N, Berger MS (2018) Surgical oncology for gliomas: the state of the art. Nat Rev Clin Oncol 15(2):112–125.  https://doi.org/10.1038/nrclinonc.2017.171 CrossRefPubMedGoogle Scholar
  10. 10.
    Roh TH, Kang SG, Moon JH, Sung KS, Park HH, Kim SH, Kim EH, Hong CK, Suh CO, Chang JH (2019) Survival benefit of lobectomy over gross-total resection without lobectomy in cases of glioblastoma in the noneloquent area: a retrospective study. J Neurosurg.  https://doi.org/10.3171/2018.12.JNS182558 CrossRefPubMedGoogle Scholar
  11. 11.
    Mikeska T, Bock C, El-Maarri O, Hubner A, Ehrentraut D, Schramm J, Felsberg J, Kahl P, Buttner R, Pietsch T, Waha A (2007) Optimization of quantitative MGMT promoter methylation analysis using pyrosequencing and combined bisulfite restriction analysis. J Mol Diagn 9(3):368–381.  https://doi.org/10.2353/jmoldx.2007.060167 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, Degroot J, Wick W, Gilbert MR, Lassman AB, Tsien C, Mikkelsen T, Wong ET, Chamberlain MC, Stupp R, Lamborn KR, Vogelbaum MA, van den Bent MJ, Chang SM (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28(11):1963–1972.  https://doi.org/10.1200/JCO.2009.26.3541 CrossRefPubMedGoogle Scholar
  13. 13.
    Herrlinger U, Tzaridis T, Mack F, Steinbach JP, Schlegel U, Sabel M, Hau P, Kortmann RD, Krex D, Grauer O, Goldbrunner R, Schnell O, Bahr O, Uhl M, Seidel C, Tabatabai G, Kowalski T, Ringel F, Schmidt-Graf F, Suchorska B, Brehmer S, Weyerbrock A, Renovanz M, Bullinger L, Galldiks N, Vajkoczy P, Misch M, Vatter H, Stuplich M, Schafer N, Kebir S, Weller J, Schaub C, Stummer W, Tonn JC, Simon M, Keil VC, Nelles M, Urbach H, Coenen M, Wick W, Weller M, Fimmers R, Schmid M, Hattingen E, Pietsch T, Coch C, Glas M, Neurooncology Working Group of the German Cancer S (2019) Lomustine-temozolomide combination therapy versus standard temozolomide therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter (CeTeG/NOA-09): a randomised, open-label, phase 3 trial. Lancet 393(10172):678–688.  https://doi.org/10.1016/s0140-6736(18)31791-4 CrossRefPubMedGoogle Scholar
  14. 14.
    Ross MI, Balch CM (2016) Excision margins of melanoma make a difference: new data support an old paradigm. Ann Surg Oncol 23(4):1053–1056.  https://doi.org/10.1245/s10434-015-4950-0 CrossRefPubMedGoogle Scholar
  15. 15.
    Crago AM, Brennan MF (2015) Principles in management of soft tissue sarcoma. Adv Surg 49:107–122.  https://doi.org/10.1016/j.yasu.2015.04.002 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    de Leeuw CN, Vogelbaum MA (2019) Supratotal resection in glioma: a systematic review. Neuro Oncol 21(2):179–188.  https://doi.org/10.1093/neuonc/noy166 CrossRefPubMedGoogle Scholar
  17. 17.
    Sanai N, Polley MY, McDermott MW, Parsa AT, Berger MS (2011) An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg 115(1):3–8.  https://doi.org/10.3171/2011.2.JNS10998 CrossRefPubMedGoogle Scholar
  18. 18.
    Grabowski MM, Recinos PF, Nowacki AS, Schroeder JL, Angelov L, Barnett GH, Vogelbaum MA (2014) Residual tumor volume versus extent of resection: predictors of survival after surgery for glioblastoma. J Neurosurg 121(5):1115–1123.  https://doi.org/10.3171/2014.7.JNS132449 CrossRefPubMedGoogle Scholar
  19. 19.
    Tonn JC, Stummer W (2008) Fluorescence-guided resection of malignant gliomas using 5-aminolevulinic acid: practical use, risks, and pitfalls. Clin Neurosurg 55:20–26PubMedGoogle Scholar
  20. 20.
    Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, Lang FF, McCutcheon IE, Hassenbusch SJ, Holland E, Hess K, Michael C, Miller D, Sawaya R (2001) A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95(2):190–198.  https://doi.org/10.3171/jns.2001.95.2.0190 CrossRefPubMedGoogle Scholar
  21. 21.
    Sawaya R (1999) Extent of resection in malignant gliomas: a critical summary. J Neurooncol 42(3):303–305CrossRefPubMedGoogle Scholar
  22. 22.
    Li YM, Suki D, Hess K, Sawaya R (2016) The influence of maximum safe resection of glioblastoma on survival in 1229 patients: can we do better than gross-total resection? J Neurosurg 124(4):977–988.  https://doi.org/10.3171/2015.5.JNS142087 CrossRefPubMedGoogle Scholar
  23. 23.
    Pessina F, Navarria P, Cozzi L, Ascolese AM, Simonelli M, Santoro A, Clerici E, Rossi M, Scorsetti M, Bello L (2017) Maximize surgical resection beyond contrast-enhancing boundaries in newly diagnosed glioblastoma multiforme: is it useful and safe? A single institution retrospective experience. J Neurooncol 135(1):129–139.  https://doi.org/10.1007/s11060-017-2559-9 CrossRefPubMedGoogle Scholar
  24. 24.
    Muzumdar D, Patil M, Goel A, Ravat S, Sawant N, Shah U (2016) Mesial temporal lobe epilepsy—an overview of surgical techniques. Int J Surg 36(Pt B):411–419.  https://doi.org/10.1016/j.ijsu.2016.10.027 CrossRefPubMedGoogle Scholar
  25. 25.
    van Kessel E, Baumfalk AE, van Zandvoort MJE, Robe PA, Snijders TJ (2017) Tumor-related neurocognitive dysfunction in patients with diffuse glioma: a systematic review of neurocognitive functioning prior to anti-tumor treatment. J Neurooncol 134(1):9–18.  https://doi.org/10.1007/s11060-017-2503-z CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Campanella F, Mondani M, Skrap M, Shallice T (2009) Semantic access dysphasia resulting from left temporal lobe tumours. Brain 132(Pt 1):87–102.  https://doi.org/10.1093/brain/awn302 CrossRefPubMedGoogle Scholar
  27. 27.
    Alpherts WC, Vermeulen J, van Rijen PC, da Silva FH, van Veelen CW, Dutch Collaborative Epilepsy Surgery P (2006) Verbal memory decline after temporal epilepsy surgery?: a 6-year multiple assessments follow-up study. Neurology 67(4):626–631.  https://doi.org/10.1212/01.wnl.0000230139.45304.eb CrossRefPubMedGoogle Scholar
  28. 28.
    Vogt VL, Witt JA, Delev D, Grote A, von Lehe M, Becker AJ, Schramm J, Elger CE, Helmstaedter C (2018) Cognitive features and surgical outcome of patients with long-term epilepsy-associated tumors (LEATs) within the temporal lobe. Epilepsy Behav 88:25–32.  https://doi.org/10.1016/j.yebeh.2018.08.028 CrossRefPubMedGoogle Scholar
  29. 29.
    Noll KR, Weinberg JS, Ziu M, Benveniste RJ, Suki D, Wefel JS (2015) Neurocognitive changes associated with surgical resection of left and right temporal lobe glioma. Neurosurgery 77(5):777–785.  https://doi.org/10.1227/NEU.0000000000000987 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Matthias Schneider
    • 1
    Email author
  • Anna-Laura Potthoff
    • 1
  • Vera C. Keil
    • 2
  • Ági Güresir
    • 1
  • Johannes Weller
    • 3
  • Valeri Borger
    • 1
  • Motaz Hamed
    • 1
  • Andreas Waha
    • 4
  • Hartmut Vatter
    • 1
  • Erdem Güresir
    • 1
  • Ulrich Herrlinger
    • 3
  • Patrick Schuss
    • 1
  1. 1.Department of NeurosurgeryRheinische Friedrich-Wilhelms-UniversityBonnGermany
  2. 2.Department of RadiologyRheinische Friedrich-Wilhelms-UniversityBonnGermany
  3. 3.Division of Clinical Neurooncology, Department of NeurologyRheinische Friedrich-Wilhelms-UniversityBonnGermany
  4. 4.Department of NeuropathologyRheinische Friedrich-Wilhelms-UniversityBonnGermany

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