| Popis: |
PURPOSE: To evaluate the published evidence addressing supratotal resection in glioma, where supratotal is defined as resection beyond all MRI abnormalities present on T1 enhanced and FLAIR modalities. METHODS: EMBASE, MEDLINE, Scopus, and Web of Science were queried using search terms designed to identify published works on supratotal resection. Records that were case studies, reviews or editorials, non-English, abstract-only, brain metastases, or only descriptive, were excluded. All others were included. RESULTS: 309 unique references yielded 41 studies for full-text review, with 7 included in the final analysis. Five originated from research in France, one from Germany, and one from Italy. All five French studies focused on low-grade glioma, whereas the remaining two focused on glioblastoma. A total of 88 patients had undergone supratotal resection in a combined cohort of 492 patients (214 males and 278 females, age 18 to 82 years). Fifty-one supratotal resections were conducted on high-grade gliomas, and 37 on low-grade gliomas. Surgical resection technologies included intraoperative MRI, cortical and subcortical functional testing, and 5-aminolevulinic acid. Studies were mostly of Oxford Center for Evidence-Based Medicine Level 4 quality. Karnofsky Performance Status, overall survival, progression-free survival, neurological deficits post-operatively, and anaplastic transformation were the main measured outcomes. No randomized controlled trials were identified. Preliminary low quality support was found for supratotal resection in increasing overall survival and progression-free survival for both low-grade and high-grade glioma. CONCLUSION: The literature suggests insufficient evidence for carte blanche application of supratotal resection, particularly in lower grade gliomas where neurological deficits can result in long-term disability. Current evidence consists of data from only a few centers without independent validation. There is a definite need for further research with larger patient populations, clearly defined metrics and comparisons to evaluate improvements by, and the involvement of multi-national/multi-center research groups. |
