Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Feb 14;21(2):179-188.
doi: 10.1093/neuonc/noy166.

Supratotal resection in glioma: a systematic review

Charles N de Leeuw  1 , Michael A Vogelbaum  2
Affiliations

Supratotal resection in glioma: a systematic review

Charles N de Leeuw et al. Neuro Oncol. .

Abstract

Background: Emerging evidence suggests survival benefit from resection beyond all MRI abnormalities present on T1-enhanced and T2‒fluid attenuated inversion recovery (FLAIR) modalities in glioma (supratotal resection); however, the quality of evidence is unclear. We addressed this question via systematic review of the literature.

Methods: EMBASE, MEDLINE, Scopus, and Web of Science databases were queried. Case studies, reviews or editorials, non-English, abstract-only, brain metastases, and descriptive works were excluded. All others were included.

Results: Three hundred and nine unique references yielded 41 studies for full-text review, with 7 included in the final analysis. Studies were mostly of Oxford Center for Evidence-Based Medicine Level 4 quality. A total of 88 patients underwent supratotal resection in a combined cohort of 492 patients (214 males and 278 females, age 18 to 82 years). Fifty-one supratotal resections were conducted on high-grade gliomas, and 37 on low-grade gliomas. Karnofsky performance status, overall survival, progression-free survival, neurological deficits postoperatively, and anaplastic transformation were the main measured outcomes. No randomized controlled trials were identified. Preliminary low-quality support was found for supratotal resection in increasing overall survival and progression-free survival for both low-grade and high-grade glioma.

Conclusion: The literature suggests insufficient evidence for carte blanche application of supratotal resection, particularly in lower-grade gliomas where neurological deficits can result in long-term disability. While the preliminary studies discussed here, containing data from only a few centers, have reported increased progression-free and overall survival, these claims require validation in prospective research studies involving larger patient populations with clearly defined appropriate outcome metrics in order to reduce potential bias.

Keywords: FLAIR; glioma; resection; supratotal; surgery.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
PRISMA flow diagram. EMBASE, MEDLINE, Scopus, and Web of Science were exhaustively searched for articles concerning supratotal resection in glioma, with reference lists also used as article sources. A total of 309 unique entries were considered for inclusion; 41 articles proceeded to full-text analysis, with 7 satisfying criteria for qualitative review, and 0 satisfying criteria for quantitative analysis.
See this image and copyright information in PMC

References

    1. Ricard D, Idbaih A, Ducray F, Lahutte M, Hoang-Xuan K, Delattre JY. Primary brain tumours in adults. Lancet. 2012;379(9830):1984–1996. - PubMed
    1. Mandonnet E, Delattre JY, Tanguy ML, et al. . Continuous growth of mean tumor diameter in a subset of grade II gliomas. Ann Neurol. 2003;53(4):524–528. - PubMed
    1. Brandes AA, Tosoni A, Franceschi E, Reni M, Gatta G, Vecht C. Glioblastoma in adults. Crit Rev Oncol Hematol. 2008;67(2):139–152. - PubMed
    1. Miranda A, Blanco-Prieto M, Sousa J, Pais A, Vitorino C. Breaching barriers in glioblastoma. Part I: molecular pathways and novel treatment approaches. Int J Pharm. 2017;531(1):372–388. - PubMed
    1. Bush NA, Chang SM, Berger MS. Current and future strategies for treatment of glioma. Neurosurg Rev. 2017;40(1):1–14. - PubMed

Publication types