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Volumetric analysis of extent of resection, survival, and surgical outcomes, for insular gliomas.
World Neurosurg. 2017 Apr 10;:
Authors: Eseonu CI, ReFaey K, Garcia O, Raghuraman G, Quinones-Hinojosa A
Abstract
BACKGROUND: Insular gliomas are challenging tumors to surgically resect due to the anatomy surrounding them. This study evaluates the role of extent of resection(EOR) and molecular markers on surgical outcome and survival for insular gliomas.
METHODS: Seventy-four patients who had undergone an initial resection for an insular glioma by the same surgeon from 2006 to 2016 were analyzed. Low(grade II) and high(grade III/IV) grade gliomas were analyzed for the prognostic role of volumetric EOR and molecular markers on patient survival outcomes.
RESULTS: The cohort includes 25 low grade gliomas (LGGs) patients(33.8%), and 49 high grade glioma(HGGs) patients(66.2%). The median EOR was 91.7%(range 10-100%). New permanent postoperative deficits were found in 2.7% of patients. LGG patients with a ≥90% EOR had a 5-year survival rate of 100% and patients with a <90% EOR had 5-year survival of 80%. HGG patients with a ≥90% EOR had a 2-year survival rate of 83.7%, and patients with a <90% EOR had 2-year survival of 43.8%. For LGGs, the EOR was predictive of OS(p=0.017), progression free survival(PFS, p=0.039), and malignant progression free survival(MPFS, p=0.014), while the 1p/19q co-deletion was predictive for PFS(p=0.014). For HGGs, the EOR was predictive of OS(p=0.020) and PFS(p=0.024). Preoperative tumor volume was a factor that most significantly affected the EOR for insular gliomas(R(2)=0.053,p=0.048).
CONCLUSION: Extensive resections of insular gliomas can be achieved with low morbidity and can improve OS and PFS. In this series of low-grade gliomas, EOR was associated with longer MPFS, and the 1p/19q co-deletion was predictive of PFS.
PMID: 28408263 [PubMed - as supplied by publisher]
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