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Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection: A report of the RANO resect group

BACKGROUND: The value of re-resection in recurrent glioblastoma remains controversial as a randomized trial that specifies intentional incomplete resection cannot be justified ethically. Here, we aimed to (1) explore the prognostic role of extent of re-resection using the previously proposed Respons...

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Autores principales: Karschnia, Philipp, Dono, Antonio, Young, Jacob S, Juenger, Stephanie T, Teske, Nico, Häni, Levin, Sciortino, Tommaso, Mau, Christine Y, Bruno, Francesco, Nunez, Luis, Morshed, Ramin A, Haddad, Alexander F, Weller, Michael, van den Bent, Martin, Beck, Juergen, Hervey-Jumper, Shawn, Molinaro, Annette M, Tandon, Nitin, Rudà, Roberta, Vogelbaum, Michael A, Bello, Lorenzo, Schnell, Oliver, Grau, Stefan J, Chang, Susan M, Berger, Mitchel S, Esquenazi, Yoshua, Tonn, Joerg-Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479742/
https://www.ncbi.nlm.nih.gov/pubmed/37253096
http://dx.doi.org/10.1093/neuonc/noad074
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author Karschnia, Philipp
Dono, Antonio
Young, Jacob S
Juenger, Stephanie T
Teske, Nico
Häni, Levin
Sciortino, Tommaso
Mau, Christine Y
Bruno, Francesco
Nunez, Luis
Morshed, Ramin A
Haddad, Alexander F
Weller, Michael
van den Bent, Martin
Beck, Juergen
Hervey-Jumper, Shawn
Molinaro, Annette M
Tandon, Nitin
Rudà, Roberta
Vogelbaum, Michael A
Bello, Lorenzo
Schnell, Oliver
Grau, Stefan J
Chang, Susan M
Berger, Mitchel S
Esquenazi, Yoshua
Tonn, Joerg-Christian
author_facet Karschnia, Philipp
Dono, Antonio
Young, Jacob S
Juenger, Stephanie T
Teske, Nico
Häni, Levin
Sciortino, Tommaso
Mau, Christine Y
Bruno, Francesco
Nunez, Luis
Morshed, Ramin A
Haddad, Alexander F
Weller, Michael
van den Bent, Martin
Beck, Juergen
Hervey-Jumper, Shawn
Molinaro, Annette M
Tandon, Nitin
Rudà, Roberta
Vogelbaum, Michael A
Bello, Lorenzo
Schnell, Oliver
Grau, Stefan J
Chang, Susan M
Berger, Mitchel S
Esquenazi, Yoshua
Tonn, Joerg-Christian
author_sort Karschnia, Philipp
collection PubMed
description BACKGROUND: The value of re-resection in recurrent glioblastoma remains controversial as a randomized trial that specifies intentional incomplete resection cannot be justified ethically. Here, we aimed to (1) explore the prognostic role of extent of re-resection using the previously proposed Response Assessment in Neuro-Oncology (RANO) classification (based upon residual contrast-enhancing (CE) and non-CE tumor), and to (2) define factors consolidating the surgical effects on outcome. METHODS: The RANO resect group retrospectively compiled an 8-center cohort of patients with first recurrence from previously resected glioblastomas. The associations of re-resection and other clinical factors with outcome were analyzed. Propensity score-matched analyses were constructed to minimize confounding effects when comparing the different RANO classes. RESULTS: We studied 681 patients with first recurrence of Isocitrate Dehydrogenase (IDH) wild-type glioblastomas, including 310 patients who underwent re-resection. Re-resection was associated with prolonged survival even when stratifying for molecular and clinical confounders on multivariate analysis; ≤1 cm(3) residual CE tumor was associated with longer survival than non-surgical management. Accordingly, “maximal resection” (class 2) had superior survival compared to “submaximal resection” (class 3). Administration of (radio-)chemotherapy in the absence of postoperative deficits augmented the survival associations of smaller residual CE tumors. Conversely, “supramaximal resection” of non-CE tumor (class 1) was not associated with prolonged survival but was frequently accompanied by postoperative deficits. The prognostic role of residual CE tumor was confirmed in propensity score analyses. CONCLUSIONS: The RANO resect classification serves to stratify patients with re-resection of glioblastoma. Complete resection according to RANO resect classes 1 and 2 is prognostic.
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spelling pubmed-104797422023-09-06 Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection: A report of the RANO resect group Karschnia, Philipp Dono, Antonio Young, Jacob S Juenger, Stephanie T Teske, Nico Häni, Levin Sciortino, Tommaso Mau, Christine Y Bruno, Francesco Nunez, Luis Morshed, Ramin A Haddad, Alexander F Weller, Michael van den Bent, Martin Beck, Juergen Hervey-Jumper, Shawn Molinaro, Annette M Tandon, Nitin Rudà, Roberta Vogelbaum, Michael A Bello, Lorenzo Schnell, Oliver Grau, Stefan J Chang, Susan M Berger, Mitchel S Esquenazi, Yoshua Tonn, Joerg-Christian Neuro Oncol Clinical Investigations BACKGROUND: The value of re-resection in recurrent glioblastoma remains controversial as a randomized trial that specifies intentional incomplete resection cannot be justified ethically. Here, we aimed to (1) explore the prognostic role of extent of re-resection using the previously proposed Response Assessment in Neuro-Oncology (RANO) classification (based upon residual contrast-enhancing (CE) and non-CE tumor), and to (2) define factors consolidating the surgical effects on outcome. METHODS: The RANO resect group retrospectively compiled an 8-center cohort of patients with first recurrence from previously resected glioblastomas. The associations of re-resection and other clinical factors with outcome were analyzed. Propensity score-matched analyses were constructed to minimize confounding effects when comparing the different RANO classes. RESULTS: We studied 681 patients with first recurrence of Isocitrate Dehydrogenase (IDH) wild-type glioblastomas, including 310 patients who underwent re-resection. Re-resection was associated with prolonged survival even when stratifying for molecular and clinical confounders on multivariate analysis; ≤1 cm(3) residual CE tumor was associated with longer survival than non-surgical management. Accordingly, “maximal resection” (class 2) had superior survival compared to “submaximal resection” (class 3). Administration of (radio-)chemotherapy in the absence of postoperative deficits augmented the survival associations of smaller residual CE tumors. Conversely, “supramaximal resection” of non-CE tumor (class 1) was not associated with prolonged survival but was frequently accompanied by postoperative deficits. The prognostic role of residual CE tumor was confirmed in propensity score analyses. CONCLUSIONS: The RANO resect classification serves to stratify patients with re-resection of glioblastoma. Complete resection according to RANO resect classes 1 and 2 is prognostic. Oxford University Press 2023-05-30 /pmc/articles/PMC10479742/ /pubmed/37253096 http://dx.doi.org/10.1093/neuonc/noad074 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Clinical Investigations
Karschnia, Philipp
Dono, Antonio
Young, Jacob S
Juenger, Stephanie T
Teske, Nico
Häni, Levin
Sciortino, Tommaso
Mau, Christine Y
Bruno, Francesco
Nunez, Luis
Morshed, Ramin A
Haddad, Alexander F
Weller, Michael
van den Bent, Martin
Beck, Juergen
Hervey-Jumper, Shawn
Molinaro, Annette M
Tandon, Nitin
Rudà, Roberta
Vogelbaum, Michael A
Bello, Lorenzo
Schnell, Oliver
Grau, Stefan J
Chang, Susan M
Berger, Mitchel S
Esquenazi, Yoshua
Tonn, Joerg-Christian
Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection: A report of the RANO resect group
title Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection: A report of the RANO resect group
title_full Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection: A report of the RANO resect group
title_fullStr Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection: A report of the RANO resect group
title_full_unstemmed Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection: A report of the RANO resect group
title_short Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection: A report of the RANO resect group
title_sort prognostic evaluation of re-resection for recurrent glioblastoma using the novel rano classification for extent of resection: a report of the rano resect group
topic Clinical Investigations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479742/
https://www.ncbi.nlm.nih.gov/pubmed/37253096
http://dx.doi.org/10.1093/neuonc/noad074
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