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Intraoperative MRI for newly diagnosed supratentorial glioblastoma: a multicenter-registry comparative study to
Amar S Shah1, Peter T Sylvester1, Alexander T Yahanda1
11Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.
Objective:
Intraoperative MRI (iMRI) is used in the surgical treatment of glioblastoma, with uncertain effects on outcomes. The authors evaluated the impact of iMRI on extent of resection (EOR) and overall survival (OS) while controlling for other known and suspected predictors.
Methods:
A multicenter retrospective cohort of 640 adult patients with newly diagnosed supratentorial glioblastoma who underwent resection was evaluated. iMRI was performed in 332/640 cases (51.9%). Reviews of MRI features and tumor volumetric analysis were performed on a subsample of cases (n = 286; 110 non-iMRI, 176 iMRI) from a single institution.
Results:
The median age was 60.0 years (mean 58.5 years, range 20.5-86.3 years). The median OS was 17.0 months (95% CI 15.6-18.4 months). Gross-total resection (GTR) was achieved in 403/640 cases (63.0%). Kaplan-Meier analysis of 286 cases with volumetric analysis for EOR (grouped into 100%, 95%-99%, 80%-94%, and 50%-79%) showed longer OS for 100% EOR compared to all other groups (p < 0.01). Additional resection after iMRI was performed in 104/122 cases (85.2%) with initial subtotal resection (STR), leading to a 6.3% mean increase in EOR and a 2.2-cm3 mean decrease in tumor volume. For iMRI cases with volumetric analysis, the GTR rate increased from 54/176 (30.7%) on iMRI to 126/176 (71.5%) postoperatively. The EOR was significantly higher in the iMRI group for intended GTR and STR groups (p = 0.02 and p < 0.01, respectively). Predictors of GTR on multivariate logistic regression included iMRI use and intended GTR. Predictors of shorter OS on multivariate Cox regression included older age, STR, isocitrate dehydrogenase 1 (IDH1) wild type, no O 6-methylguanine DNA methyltransferase (MGMT) methylation, and no Stupp therapy. iMRI was a significant predictor of OS on univariate (HR 0.82, 95% CI 0.69-0.98; p = 0.03) but not multivariate analyses. Use of iMRI was not associated with an increased rate of new permanent neurological deficits.
Conclusions:
GTR increased OS for patients with newly diagnosed glioblastoma after adjusting for other prognostic factors. iMRI increased EOR and GTR rate and was a significant predictor of GTR on multivariate analysis; however, iMRI was not an independent predictor of OS. Additional supporting evidence is needed to determine the clinical benefit of iMRI in the management of glioblastoma.
Insights
Intraoperative MRI (iMRI) improved extent of resection (EOR) and gross-total resection (GTR) rates in glioblastoma surgery. While iMRI use was linked to better outcomes, it was not an independent predictor of overall survival (OS).
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Intraoperative MRI (iMRI) is utilized in glioblastoma surgery, but its impact on patient outcomes remains unclear.
- Glioblastoma resection aims to maximize extent of resection (EOR) for improved survival, with gross-total resection (GTR) being the goal.
Purpose of the Study:
- To evaluate the effect of iMRI on EOR and overall survival (OS) in glioblastoma patients.
- To identify predictors of GTR and OS, controlling for confounding factors.
Main Methods:
- A multicenter retrospective cohort study of 640 newly diagnosed supratentorial glioblastoma patients.
- iMRI was used in 51.9% of cases. Volumetric analysis was performed on a subsample (n=286) to assess EOR.
- Statistical analyses included Kaplan-Meier, multivariate logistic regression for GTR, and multivariate Cox regression for OS.
Main Results:
- Gross-total resection (GTR) was associated with significantly longer OS (p < 0.01).
- iMRI use increased EOR by 6.3% and GTR rates (from 30.7% to 71.5% in iMRI cases).
- iMRI was a significant predictor of GTR (p=0.02), but not an independent predictor of OS on multivariate analysis.
Conclusions:
- Gross-total resection (GTR) significantly improves overall survival (OS) in glioblastoma patients.
- Intraoperative MRI (iMRI) enhances EOR and GTR rates, but further evidence is needed to confirm its independent clinical benefit on OS.
