Cytoreductive surgery in the management of newly diagnosed glioblastoma in adults: a systematic review and evidence-based clinical practice guideline update.

Autor: Domino JS; Department of Neurosurgery, University of Kansas School of Medicine, Kansas City, KS, USA. jdomino@kumc.edu.; Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3021, Kansas City, KS, 66160, USA. jdomino@kumc.edu., Ormond DR; Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA., Germano IM; Department of Neurosurgery, The Mount Sinai Medical Center, New York, NY, USA., Sami M; Department of Neurosurgery, University of Kansas School of Medicine, Kansas City, KS, USA., Ryken TC; Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA., Olson JJ; Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
Jazyk: angličtina
Zdroj: Journal of neuro-oncology [J Neurooncol] 2020 Nov; Vol. 150 (2), pp. 121-142. Date of Electronic Publication: 2020 Nov 19.
DOI: 10.1007/s11060-020-03606-5
Abstrakt: Target Population: These recommendations apply to adults with newly diagnosed or suspected glioblastoma.
Question: What is the effect of extent of surgical resection on patient outcome in the initial management of adult patients with suspected newly diagnosed glioblastoma?
Recommendation: Level II: Maximal cytoreductive surgery is recommended in adult patients with suspected newly diagnosed supratentorial glioblastoma with gross total resection defined as removal of contrast enhancing tumor. Level III: Biopsy, subtotal resection, or gross total resection is suggested depending on medical comorbidities, functional status, and location of tumor if maximal resection may cause significant neurologic deficit.
Question: What is the role of cytoreductive surgery in adults with newly diagnosed bi-frontal "butterfly" glioblastoma?
Recommendation: Level III: Resection of newly diagnosed bi-frontal "butterfly" glioblastoma is suggested to improve overall survival over biopsy alone.
Question: What is the goal of cytoreductive surgery in elderly adult patients with newly diagnosed glioblastoma?
Recommendation: Level III: Elderly patients (> 65 years) show survival benefit with gross total resection and it is suggested they undergo cytoreductive surgery.
Question: What is the role of advanced intraoperative guidance techniques in cytoreductive surgery in adults with newly diagnosed glioblastoma?
Recommendation: Level III: The use of intraoperative guidance adjuncts such as intraoperative MRI (iMRI) or 5-aminolevulinic acid (5-ALA) are suggested to maximize extent of resection in newly diagnosed glioblastoma. There is insufficient evidence to make a suggestion on the use of fluorescein, indocyanine green, or intraoperative ultrasound.
Databáze: MEDLINE
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