title: The influence of intraoperative resection control modalities on survival following gross total resection of glioblastoma.
abstract: The purpose of the present study is to analyze the impact of intraoperative resection control modalities on overall survival (OS) and progression-free survival (PFS) following gross total resection (GTR) of glioblastoma. We analyzed data of 76 glioblastoma patients (30f, mean age 57.4 ± 11.6 years) operated at our institution between 2009 and 2012. Patients were only included if GTR was achieved as judged by early postoperative high-field MRI. Intraoperative technical resection control modalities comprised intraoperative ultrasound (ioUS, n = 48), intraoperative low-field MRI (ioMRI, n = 22), and a control group without either modality (n = 11). The primary endpoint of our study was OS, and the secondary endpoint was PFS-both analyzed in Kaplan-Meier plots and Cox proportional hazards models. Median OS in all 76 glioblastoma patients after GTR was 20.4 months (95 % confidence interval (CI) 18.5-29.0)-median OS in patients where GTR was achieved using ioUS was prolonged (21.9 months) compared to those without ioUS usage (18.8 months). A multiple Cox model adjusting for age, preop Karnofsky performance status, tumor volume, and the use of 5-aminolevulinic acid showed a beneficial effect of ioUS use, and the estimated hazard ratio was 0.63 (95 % CI 0.31-1.2, p = 0.18) in favor of ioUS, however not reaching statistical significance. A similar effect was found for PFS (hazard ratio 0.59, p = 0.072). GTR of glioblastoma performed with ioUS guidance was associated with prolonged OS and PFS. IoUS should be compared to other resection control devices in larger patient cohorts.
authors: Department of Neurosurgery, University Hospital, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland.
authors: Marian C
authors: MC
authors: Neidert
authors: Department of Neurosurgery, University Hospital, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland.
authors: Isabel C
authors: IC
authors: Hostettler
authors: Department of Neurosurgery, University Hospital, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland.
authors: Jan-Karl
authors: JK
authors: Burkhardt
authors: Department of Neurosurgery, University Hospital, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland.
authors: Malte
authors: M
authors: Mohme
authors: Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland.
authors: Ulrike
authors: U
authors: Held
authors: Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland.
authors: Reto
authors: R
authors: Kofmehl
authors: Department of Neurology, University Hospital, University of Zurich, Zurich, Switzerland.
authors: Günter
authors: G
authors: Eisele
authors: Department of Neurosurgery, University Hospital, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland.
authors: Christoph M
authors: CM
authors: Woernle
authors: Department of Neurosurgery, University Hospital, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland.
authors: Luca
authors: L
authors: Regli
authors: Department of Neurosurgery, University Hospital, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland. oliver.bozinov@usz.ch.
authors: Oliver
authors: O
authors: Bozinov
mesh_terms: D001932:Brain Neoplasms / Q000401:mortality* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D017567:Karnofsky Performance Status / Q000706:statistics & numerical data; D008297:Male; D018365:Neoplasm, Residual / Q000401:mortality / Q000473:pathology; D019635:Neurosurgical Procedures; D016016:Proportional Hazards Models; D016896:Treatment Outcome
keywords: Glioblastoma; Intraoperative magnetic resonance imaging; Intraoperative ultrasound; Survival; ioMRI; ioUS