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Review
. 2021 May:149:23-33.
doi: 10.1016/j.ejca.2021.03.002. Epub 2021 Apr 2.

Evidence-based recommendations on categories for extent of resection in diffuse glioma

Philipp Karschnia  1 , Michael A Vogelbaum  2 , Martin van den Bent  3 , Daniel P Cahill  4 , Lorenzo Bello  5 , Yoshitaka Narita  6 , Mitchel S Berger  7 , Michael Weller  8 , Joerg-Christian Tonn  9
Affiliations
Free article
Review

Evidence-based recommendations on categories for extent of resection in diffuse glioma

Philipp Karschnia et al. Eur J Cancer. 2021 May.
Free article

Abstract

Surgical resection represents the standard of care in diffuse glioma, and more extensive tumour resection appears to be associated with favourable outcome. Up to now, terminology to describe extent of resection has been inconsistently applied across clinical trials which hampers comparative analysis of cohorts between different studies. Based on a comprehensive literature review, we developed evidence-based expert recommendations on categories for extent of resection. Recommendations are formulated for the categories 'biopsy', 'partial resection', 'subtotal resection', 'near total resection', 'complete resection' and 'supramaximal resection'. Definitions rest on reduction of contrast- and non-contrast-enhancing tumour in glioblastoma, and on reduction of T2/FLAIR-hyperintense tumour in gliomas WHO grade 2 or 3. Both relative reduction of tumour volume (in percentage) as a measurement of surgical efficacy and absolute residual tumour volume (in cm3) as a measurement of remaining tumour burden are incorporated into the categories for extent of resection. Class of evidence for the proposed categories ranges from class IIB to IV. Limitations of the suggested categories are discussed. The proposed categories on extent of resection offer a framework to standardize nomenclature based on previous studies, and will need to be evaluated in prospective, molecularly well-defined cohorts. Our categories may eventually help as a stratification factor for future clinical trials.

Keywords: Diffuse glioma; Extent of resection; Glioblastoma; MRI; Nomenclature; Surgical resection.

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Conflict of interest statement

Conflict of interest statement The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Philipp Karschnia—Research grants from the “Support Program for Research and Teaching” (FöFoLe) at the Ludwig-Maximilians-University Munich and the Friedrich-Baur-Foundation. Michael A. Vogelbaum—Indirect equity and patient royalty interests from Infuseon Therapeutics. Honoraria from Celgene, Tocagen, and Blue Earth Diagnostics. Martin van den Bent—Consultant for Celgene, BMS, Agios, Boehringer, Abbvie, Bayer, Carthera, Nerviano, and Genenta. Daniel P. Cahill—Consultation fees from Eli Lilly and Boston Pharmaceuticals. Honoraria. Travel reimbursement from Merck for invited lectures and from the US NIH and DOD for grant review. Lorenzo Bello—No disclosures reported. Yoshitaka Narita—Research grants from Abbvie, Ono Pharmaceutical Co., Dainippon-Sumitomo, Eisai, Stella-pharma. Speaker honoraria from Chugai Pharmaceutical Co. and Novocure. Mitchel S. Berger—No disclosures reported. Michael Weller—Research grants from Abbvie, Adastra, Bristol Meyer Squibb (BMS), Dracen, Merck, Sharp & Dohme (MSD), Merck (EMD), Novocure, Piqur, and Roche. Honoraria for lectures or advisory board participation or consulting from Abbvie, Basilea, Bristol Meyer Squibb (BMS), Celgene, Merck, Sharp & Dohme (MSD), Merck (EMD), Novocure, Orbus, Roche and Tocagen. Joerg-Christian Tonn—Consultant/speaker honoraria from BrainLab and Carthera, and royalties from Springer Publisher Intl.

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