Clinical Uncertainty and Equipoise in the Management of Recurrent Glioblastoma.

Autor:	Patel M; Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre., Au K; Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre., Davis FG; School of Public Health, University of Alberta., Easaw JC; Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB., Mehta V; Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre., Broad R; Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre., Chow MMC; Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre., Hockley A; Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre., Kaderali Z; Section of Neurosurgery, GB1-Health Sciences Centre, Winnipeg, MB, Canada., Magro E; Neurosurgery service, CHU Cavale Blanche, INSERM UMR 1101 LaTIM, Boulevard Tanguy-Prigent Brest, France., Nataraj A; Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre., Scholtes F; Department of Neurosurgery, CHU Liège, Liège, Belgium., Chagnon M; Department of Mathematics and Statistics, André-Aisenstadt Pavillon (AA-5190)., Gevry G; Department of Radiology, Centre Hospitalier of University of Montreal (CHUM), Montreal, QC, Canada., Raymond J; Department of Radiology, Centre Hospitalier of University of Montreal (CHUM), Montreal, QC, Canada., Darsaut TE; Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre.
Jazyk:	angličtina
Zdroj:	American journal of clinical oncology [Am J Clin Oncol] 2021 Jun 01; Vol. 44 (6), pp. 258-263.
DOI:	10.1097/COC.0000000000000812
Abstrakt:	Background: A significant proportion of glioblastoma (GBM) patients are considered for repeat resection, but evidence regarding best management remains elusive. Our aim was to measure the degree of clinical uncertainty regarding reoperation for patients with recurrent GBM. Methods: We first performed a systematic review of agreement studies examining the question of repeat resection for recurrent GBM. An electronic portfolio of 37 pathologically confirmed recurrent GBM patients including pertinent magnetic resonance images and clinical information was assembled. To measure clinical uncertainty, 26 neurosurgeons from various countries, training backgrounds, and years' experience were asked to select best management (repeat surgery, other nonsurgical management, or conservative), confidence in recommended management, and whether they would include the patient in a randomized trial comparing surgery with nonsurgical options. Agreement was evaluated using κ statistics. Results: The literature review did not reveal previous agreement studies examining the question. In our study, agreement regarding best management of recurrent GBM was slight, even when management options were dichotomized (repeat surgery vs. other options; κ=0.198 [95% confidence interval: 0.133-0.276]). Country of practice, years' experience, and training background did not change results. Disagreement and clinical uncertainty were more pronounced within clinicians with (κ=0.167 [0.055-0.314]) than clinicians without neuro-oncology fellowship training (κ=0.601 [0.556-0.646]). A majority (51%) of responders were willing to include the patient in a randomized trial comparing repeat surgery with nonsurgical alternatives in 26/37 (69%) of cases. Conclusion: There is sufficient uncertainty and equipoise regarding the question of reoperation for patients with recurrent glioblastoma to support the need for a randomized controlled trial. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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