title: Residual Tumor Volume as Best Outcome Predictor in Low Grade Glioma - A Nine-Years Near-Randomized Survey of Surgery vs. Biopsy.
abstract: Diffuse low grade gliomas (DLGG) are continuously progressive primary brain neoplasms that lead to neurological deficits and death. Treatment strategies are controversial. Randomized trials establishing the prognostic value of surgery do not exist. Here, we report the results of a nine-year near-randomized patient distribution between resection and biopsy. Until 2012, the Department of Neurosurgery and the Department of Stereotactic Neurosurgery at the University Medical Center Freiburg were organized as separate administrative units both coordinating DLGG patient treatment independently. All consecutive adult patients with a new diagnosis of DLGG by either stereotactic biopsy or resection were included. Pre- and post-operative tumor volumetry was performed. 126 patients, 87 men (69%), 39 women (31%), median age 41 years, were included. 77 (61%) were initially managed by biopsy, 49 (39%) by resection. A significant survival benefit was found for patients with an initial management by resection (5-year OS 82% vs. 54%). The survival benefit of patients with initial resection was reserved to patients with a residual tumor volume of less than 15 cm(3). Maximum safe resection is the first therapy of choice in DLGG patients if a near-complete tumor removal can be achieved. Accurate prediction of the extent-of-resection is required for selection of surgical candidates.
authors: Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.|Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Breisacher Str. 64, 79106. Freiburg, Germany.
authors: Roland
authors: R
authors: Roelz
authors: Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Breisacher Str. 64, 79106. Freiburg, Germany.
authors: David
authors: D
authors: Strohmaier
authors: Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.|Department of Neurosurgery, University Hospital Essen, Hufeland str. 55, 45147, Germany.
authors: Ramazan
authors: R
authors: Jabbarli
authors: Department of Nursing-IT, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
authors: Rainer
authors: R
authors: Kraeutle
authors: Department of Neuroradiology, Medical Center - University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.
authors: Karl
authors: K
authors: Egger
authors: Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Breisacher Str. 64, 79106. Freiburg, Germany.
authors: Volker A
authors: VA
authors: Coenen
authors: Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.
authors: Astrid
authors: A
authors: Weyerbrock
authors: Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Breisacher Str. 64, 79106. Freiburg, Germany.
authors: Peter C
authors: PC
authors: Reinacher
mesh_terms: D000328:Adult; D001706:Biopsy; D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005910:Glioma / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D018365:Neoplasm, Residual / Q000473:pathology*; D019635:Neurosurgical Procedures; D017063:Outcome Assessment, Health Care / Q000379:methods; D011379:Prognosis; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D047368:Tumor Burden