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Survival benefit of lobectomy over gross-total resection without lobectomy in cases of primary glioblastoma in non-eloquent area: a retrospective study

 Tae Hoon Roh  ;  Seok-Gu Kang  ;  Ju Hyung Moon  ;  Kyoung Su Sung  ;  Hun Ho Park  ;  Se Hoon Kim  ;  Eui Hyun Kim  ;  Chang-Ki Hong  ;  Chang-Ok Suh  ;  Jong Hee Chang 
 JOURNAL OF NEUROSURGERY, Vol.132(3) : 895-901, 2020 
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5-ALA = 5-aminolevulinic acid ; DTI = diffusion tensor imaging ; GBM = glioblastoma ; GTR = gross-total resection ; IDH = isocitrate dehydrogenase ; KPS = Karnofsky Performance Status ; MGMT = O6-DNA-methylguanine methyltransferase ; OS = overall survival ; PFS = progression-free survival ; SupTR = supratotal resection ; glioblastoma ; oncology ; prognosis ; supratotal resection ; survival
OBJECTIVE: Following resection of glioblastoma (GBM), microscopic remnants of the GBM tumor remaining in nearby tissue cause tumor recurrence more often than for other types of tumors, even after gross-total resection (GTR). Although surgical oncologists traditionally resect some of the surrounding normal tissue, whether further removal of nearby tissue may improve survival in GBM patients is unknown. In this single-center retrospective study, the authors assessed whether lobectomy confers a survival benefit over GTR without lobectomy when treating GBMs in the noneloquent area. METHODS: The authors selected 40 patients who had undergone GTR of a histopathologically diagnosed isocitrate dehydrogenase (IDH)-wild type GBM in the right frontal or temporal lobe and divided the patients into 2 groups according to whether GTR of the tumor involved lobectomy, defined as a supratotal resection (SupTR group, n = 20) or did not (GTR group, n = 20). Progression-free survival (PFS), overall survival (OS), and Karnofsky Performance Status (KPS) scores were compared between groups (p ≤ 0.05 for statistically significant differences). RESULTS: The median postoperative PFS times for each group were as follows: GTR group, 11.5 months (95% CI 8.8-14.2) and SupTR group, 30.7 months (95% CI 4.3-57.1; p = 0.007). The median postoperative OS times for each group were as follows: GTR group, 18.7 months (95% CI 14.3-23.1) and SupTR group, 44.1 months (95% CI 25.1-63.1; p = 0.040). The mean postoperative KPS scores (GTR, 76.5; SupTR, 77.5; p = 0.904) were not significantly different. In multivariate analysis, survival for the SupTR group was significantly longer than that for the GTR group in terms of both PFS (HR 0.230; 95% CI 0.090-0.583; p = 0.002) and OS (HR 0.247; 95% CI 0.086-0.704; p = 0.009). CONCLUSIONS: In cases of completely resectable, noneloquent-area GBMs, SupTR provides superior PFS and OS without negatively impacting patient performance.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Gu(강석구) ORCID logo https://orcid.org/0000-0001-5676-2037
Kim, Se Hoon(김세훈) ORCID logo https://orcid.org/0000-0001-7516-7372
Kim, Eui Hyun(김의현) ORCID logo https://orcid.org/0000-0002-2523-7122
Moon, Ju Hyung(문주형)
Park, Hun Ho(박현호) ORCID logo https://orcid.org/0000-0002-2526-9693
Suh, Chang Ok(서창옥)
Chang, Jong Hee(장종희) ORCID logo https://orcid.org/0000-0003-1509-9800
Hong, Chang Ki(홍창기) ORCID logo https://orcid.org/0000-0002-2761-0373
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