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A consensus definition of supratotal resection for anatomically distinct primary glioblastoma: an AANS/CNS Section on Tumors survey of neurosurgical oncologists

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Abstract

Introduction

Supratotal resection (SpTR) of glioblastoma may be associated with improved survival, but published results have varied in part from lack of consensus on the definition and appropriate use of SpTR. A previous small survey of neurosurgical oncologists with expertise performing SpTR found resection 1–2 cm beyond contrast enhancement was an acceptable definition and glioblastoma involving the right frontal and bilateral anterior temporal lobes were considered most amenable to SpTR. The general neurosurgical oncology community has not yet confirmed the practicality of this definition.

Methods

Seventy-six neurosurgical oncology members of the AANS/CNS Tumor Section were surveyed, representing 34.0% of the 223 members who were administered the survey. Participants were presented with 11 definitions of SpTR and rated each definition’s appropriateness. Participants additionally reviewed magnetic resonance imaging for 10 anatomically distinct glioblastomas and assessed the tumor location’s eloquence, perceived equipoise of enrolling patients in a randomized trial comparing gross total to SpTR, and their personal treatment plans.

Results

Most neurosurgeons surveyed agree that gross total plus resection of some non-contrast enhancement (n = 57, 80.3%) or resection 1–2 cm beyond contrast enhancement (n = 52, 73.2%) are appropriate definitions for SpTR. Cases were divided into three anatomically distinct groups by perceived equipoise between gross total and SpTR. The best clinical trial candidates were thought to be right anterior temporal (n = 58, 76.3%) and right frontal (n = 55, 73.3%) glioblastomas.

Conclusion

Support exists among neurosurgical oncologists with varying familiarity performing SpTR to adopt the proposed consensus definition of SpTR of glioblastoma and to potentially investigate the utility of SpTR to treat right anterior temporal and right frontal glioblastomas in a clinical trial. A smaller proportion of general neurosurgical oncologists than SpTR experts would personally treat a left anterior temporal glioblastoma with SpTR.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding authors on reasonable request.

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Acknowledgements

The authors would like to thank Erinma Elibe, MPH and Kristin Zerfas for their contributions toward creating and distributing the online survey, respectively. We would also like to acknowledge members of the Johns Hopkins Neuro-Oncology Surgical Outcomes Lab for their valuable input that has helped inform this project.

Funding

The authors acknowledge assistance for clinical data coordination and retrieval from the Core for Clinical Research Data Acquisition, supported in part by the Johns Hopkins Institute for Clinical and Translational Research (UL1TR001079). The authors received no remuneration for the authorship and/or publication of this article.

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Authors and Affiliations

  1. Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA

    Maureen Rakovec, Oren Wei, David Day & Debraj Mukherjee

  2. Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA

    Adham M. Khalafallah

  3. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, 22903, USA

    Jason P. Sheehan

  4. West Virginia University, Eastern Division, 800 North Tennessee Avenue, Suite 104, Martinsburg, WV, 25401, USA

    Jonathan H. Sherman

  5. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA

    Debraj Mukherjee

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  1. Maureen Rakovec
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Contributions

MR: Methodology, Formal Analysis, Writing—Original Draft, Review and Editing. AMK: Conceptualization, Methodology. OW: Formal Analysis, Writing—Original Draft, Review and Editing. DD: Formal Analysis, Writing—Original Draft, Review and Editing. JPS: Data Acquisition, Writing—Review and Editing. JHS: Data Acquisition, Writing—Review and Editing. DM: Conceptualization, Supervision, Writing—Review and Editing.

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We found no applicable reporting guidelines that would apply to this article. By following the EQUATOR reporting guidelines decision tree, (http://www.equatornetwork.org/wp-content/uploads/2013/11/20160226-RG-decision-tree-for-Wizard-CC-BY-26-February-2016.pdf), we found that none of the most popular checklists are appropriate for our study design.

Corresponding author

Correspondence to Debraj Mukherjee.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was reviewed and approved by the Johns Hopkins institutional review board (IRB00196609).

Consent to participate

This study was exempt from obtaining patient consent from patients whose radiographic data was used to generate the survey, as all data was de-identified as required by Health Insurance Portability and Accountability Act (HIPAA) regulations and institutional review board protocol (IRB00196609).

Informed consent

Informed consent was obtained from all participants who completed the survey.

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Rakovec, M., Khalafallah, A.M., Wei, O. et al. A consensus definition of supratotal resection for anatomically distinct primary glioblastoma: an AANS/CNS Section on Tumors survey of neurosurgical oncologists. J Neurooncol 159, 233–242 (2022). https://doi.org/10.1007/s11060-022-04048-x

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