• World Neurosurg · Mar 2020

    Multicenter Study

    A multi-institutional analysis of factors influencing surgical outcomes for patients with newly diagnosed grade I gliomas.

    • Alexander T Yahanda, Bhuvic Patel, Garnette Sutherland, John Honeycutt, Randy L Jensen, Matthew D Smyth, David D Limbrick, Ralph G Dacey, Joshua L Dowling, Gavin P Dunn, Albert H Kim, Eric C Leuthardt, Keith M Rich, Gregory J Zipfel, Jeffrey R Leonard, Daniel P Cahill, Mitesh V Shah, Steven R Abram, John Evans, Yu Tao, and Michael R Chicoine.
    • Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA. Electronic address: ayahanda@wustl.edu.
    • World Neurosurg. 2020 Mar 1; 135: e754-e764.

    ObjectiveTo assess the impact of intraoperative magnetic resonance imaging (iMRI), extent of resection (EOR), and other factors on overall survival (OS) and progression-free survival (PFS) for patients with newly diagnosed grade I gliomas.MethodsA multicenter database was queried to identify patients with grade I gliomas. Retrospective analyses assessed the impact of patient, treatment, and tumor characteristics on OS and PFS.ResultsA total of 284 patients underwent treatment for grade I gliomas, including 248 resections (205 with iMRI, 43 without), 23 biopsies, and 13 laser interstitial thermal therapy treatments. Log-rank analyses of Kaplan-Meier plots showed improved 5-year OS (P = 0.0107) and PFS (P = 0.0009) with increasing EOR, and a trend toward improved 5-year OS for patients with lower American Society of Anesthesiologists score (P = 0.0528). Greater EOR was associated with significantly increased 5-year PFS for pilocytic astrocytoma (P < 0.0001), but not for ganglioglioma (P = 0.10) or dysembryoplastic neuroepithelial tumor (P = 0.57). Temporal tumors (P = 0.04) and location of "other" (P = 0.04) were associated with improved PFS, and occipital/parietal tumors (P = 0.02) were associated with decreased PFS compared with all other locations. Additional tumor resection was performed after iMRI in 49.7% of cases using iMRI, which produced gross total resection in 64% of these additional resection cases.ConclusionsPatients with grade I gliomas have extended OS and PFS, which correlates positively with increasing EOR, especially for patients with pilocytic astrocytoma. iMRI may increase EOR, indicated by the rate of gross total resection after iMRI use but was not independently associated with increased OS or PFS.Copyright © 2019 Elsevier Inc. All rights reserved.

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