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Long-term outcome and survival of surgically treated supratentorial low-grade glioma in adult patients

  • Clinical Article
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Acta Neurochirurgica Aims and scope Submit manuscript

An Erratum to this article was published on 04 September 2009

Abstract

Purpose

The appropriate management of low-grade gliomas is still a matter of debate. So far, there are no randomized studies that analyze the impact of surgical resection on patient outcome. The value of the data obtained from the few retrospective reports available is often limited.

Patients and methods

In the present study, we performed an analysis on data of 130 adult low-grade glioma patients. Extent of the resection was evaluated in correlation to the overall survival (OS) and progression-free survival (PFS) using Cox regression multivariate analysis.

Results

Extended surgery was shown to prolong OS and PFS significantly. Re-surgery in the case of a tumor relapse has a significant impact on OS and PFS, too.

Conclusions

In summary, we could retrospectively evaluate a large case series of well-defined low-grade gliomas patients with a long follow-up period showing that extended surgery would be the most effective therapy for low-grade glioma patients even in recurrent diseases.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Heidelberg, INF 400, 69120, Heidelberg, Germany

    Ahmadi Rezvan, Dictus Christine, Zürn Olga, Herold-Mende Christel, Wirtz Christian Rainer & Unterberg Andreas

  2. Clinical cooperation unit of Neuropathology, German Cancer Research Center, 69120, Heidelberg, Germany

    Hartmann Christian

  3. Institute of Biostatistics, German Cancer Research Center, 69120, Heidelberg, Germany

    Edler Lutz

  4. Department of Neuroradiology, University of Heidelberg, 69120, Heidelberg, Germany

    Hartmann Marius

  5. Department of Radiation Oncology, University of Heidelberg, 69120, Heidelberg, Germany

    Combs Stephanie

Authors
  1. Ahmadi Rezvan
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  2. Dictus Christine
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Correspondence to Ahmadi Rezvan.

Additional information

Comment

The trick about low-grade gliomas surgery is first to know exactly where the tumor is, and then to take it out without hurting eloquent brain. Over the last 18 years, the time span of the current study, different approaches have emerged, including more complex brain MRI acquisitions, neuronavigation, intra-operative brain electrical recording, and intra-operative MRI, in an attempt to better redefine the target lesion and, thus, maximize surgical resection of tumors. The impact of these technologies in outcome can be huge, and this is the reason why it makes much more sense to segregate the cohort of 130 patients of this study into two groups: historical controls vs. contemporary patients. Duffau H and coworkers, in their seminal paper pursued this approach, cleverly avoiding a technical error in the manuscript design called historical bias. From a scientific point of view, it would be very interesting to have a graph plotting the survival time in months/years against the percentage of volume resection, in order to appreciate the progressive gain in outcome in terms of progressive tumor removal. I am convinced that this relationship is not a linear one, as the dichotomized analysis of the data offered in this paper may suggest. This could have major implications for the surgical management of low-grade tumors. In summary, the paper presents valuable contributions to the neurosurgical knowledge and corroborates the findings presented by others groups, including our own approach over the last few years.

Oscar L Alves

Porto, Portugal

An erratum to this article can be found at http://dx.doi.org/10.1007/s00701-009-0473-4

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Rezvan, A., Christine, D., Christian, H. et al. Long-term outcome and survival of surgically treated supratentorial low-grade glioma in adult patients. Acta Neurochir 151, 1359–1365 (2009). https://doi.org/10.1007/s00701-009-0435-x

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