title: Value of Surgical Resection in Patients with Newly Diagnosed Grade III Glioma Treated in a Multimodal Approach: Surgery, Chemotherapy and Radiotherapy.
abstract: Current treatments in grade III gliomas include surgery, radiotherapy, and chemotherapy. The value of the entity of surgical resection remains an open question. The aim of this evaluation was to analyze the impact of extent of resection (EOR) and residual tumor volume (RTV) on progression-free survival (PFS) and overall survival (OS) in patients with newly diagnosed grade III gliomas.
  
  
  
  Overall, 136 patients were included in this evaluation. EOR and RTV were defined in all patients on postoperative volumetric magnetic resonance imaging, with EOR being defined as the rate of surgical resection, and RTV as contrast-enhancing RTV (CE-RTV) and fluid-attenuated inversion recovery (FLAIR) RTV. A threshold of EOR and RTV was recorded using increments of 2 % and 1 cm(3).
  
  
  
  EOR and RTV were the only clinical variables influencing PFS and OS. The EOR cut-off value for conditioning survival was 76 %. For EOR ≥76 % or <76 %, the 5- to 10-year PFS was 57 % and 18 % versus 0 % (p = 0.03), and 5- to 10-year OS was 68 % and 42 % versus 0 % (p = 0.06), respectively. Additionally, the RTV cut-off value was 3 cm(3); for RTV <3 cm(3) or >3 cm(3), 5- to 10-year PFS was 64.3 % and 48.2 % versus 42 % and 0 % (p = 0.02), and 5- to 10-year OS was 66.8 % and 33.4 % versus 56 % and 0 % (p = 0.3), respectively. RTV was a more significant parameter conditioning PFS and OS than EOR (p = 0.04), and the presence of CE-RTV was an unfavorable prognostic factor compared with FLAIR-RTV.
  
  
  
  In heterogeneous lesions from a radiological point of view as WHO grade III gliomas if a complete removal is not possible, it would be advisable to maximize the removal of enhancing areas, possibly with an EOR >76 % and an RTV <3 cm(3).
authors.affiliation: Department of Neurosurgery, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pessina
authors.affiliation: Department of Radiotherapy, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Pierina
authors.initials: P
authors.lastname: Navarria
authors.affiliation: Department of Radiotherapy, Istituto Clinico Humanitas, Milan, Italy. luca.cozzi@humanitas.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.affiliation: Department of Radiotherapy, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ascolese
authors.affiliation: Department of Oncology and Hematology, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Simonelli
authors.affiliation: Department of Oncology and Hematology, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Department of Radiotherapy, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tomatis
authors.affiliation: Department of Neurosurgery, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Riva
authors.affiliation: Department of Neurosurgery, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Fava
authors.affiliation: Department of Radiotherapy, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
authors.affiliation: Department of Neurosurgery, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bello
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D003287:Contrast Media; D005260:Female; D005910:Glioma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media