Biopsy versus resection for high-grade glioma

Area of Science:

• Neurosurgery
• Oncology
• Clinical Effectiveness Research

Background:

• High-grade glioma (HGG) presents patients with two initial surgical options: biopsy or resection.
• The choice between biopsy and resection for HGG is often uncertain, with divided opinions on risks and benefits.
• This review is an update of previous versions published in 2000, 2003, 2007, and 2010.

Purpose of the Study:

• To evaluate the clinical effectiveness of surgical resection versus biopsy for patients with a new presumptive diagnosis of high-grade glioma (HGG).

Main Methods:

• Searches of CENTRAL, MEDLINE, and Embase were updated to September 2018.
• Handsearching of specific neuro-oncology journals and conference abstracts was conducted.
• Included were randomized controlled trials (RCTs) of any biopsy or resection at initial presentation for presumed HGG.

Main Results:

• Only one randomized controlled trial (RCT) met the inclusion criteria for biopsy versus resection in presumed HGG.
• The methodology of the included RCT was deemed inadequate for drawing reliable conclusions.
• An RCT in elderly HGG patients is underway, with results anticipated in 2019.

Conclusions:

• There is a lack of high-quality evidence to guide the initial surgical management of high-grade glioma (HGG).
• The single included RCT had methodological limitations, preventing definitive conclusions.
• Further large, multicenter RCTs are necessary to establish whether biopsy or resection is the optimal initial surgical strategy for HGG.