Results of a multicenter survey showing interindividual variability among neurosurgeons when deciding on the radicality of surgical resection in glioblastoma highlight the need for more objective guidelines

• J. Capellades ^[3] ; C. Balana ^[4] ; P. Teixidor ^[2] ; G. Villalba ^[3] ; C. Hostalot ^[2] ; G. Plans ^[1] ; R. Armengol ^[2] ; S. Medrano ^[3] ; A. Estival ^[4] ; R. Luque ^[5] ; S. Gonzalez ^[3] ; M. Gil-Gil ^[6] ; S. Villa ^[4] ; J. Sepulveda ^[7] ; J. J. García-Mosquera ^[4]
  1. [1] Hospital Universitari de Bellvitge

     Hospital Universitari de Bellvitge

     l'Hospitalet de Llobregat, España

     
  2. [2] Hospital Universitari Germans Trias i Pujol

     Hospital Universitari Germans Trias i Pujol

     Barcelona, España

     
  3. [3] Hospital del MarBarcelonaSpain
  4. [4] Institut Catala d’OncologiaHospital Universitari Germans Trias i Pujol, IGTPBadalonaSpain
  5. [5] Hospital Universitario Virgen de las NievesGranadaSpain
  6. [6] Institut Catala d’OncologiaHospital Duran i Reynals, IDIBELLBarcelonaSpain
  7. [7] Hospital Universitario 12 de OctubreMadridSpain

  Mostrar afiliaciones +
• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 19, Nº. 6, 2017, págs. 727-734
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Purpose We assessed agreement among neurosurgeons on surgical approaches to individual glioblastoma patients and between their approach and those recommended by the topographical staging system described by Shinoda.

    Methods Five neurosurgeons were provided with pre-surgical MRIs of 76 patients. They selected the surgical approach [biopsy, partial resection, or gross total resection (GTR)] that they would recommend for each patient. They were blinded to each other’s response and they were told that patients were younger than 50 years old and without symptoms. Three neuroradiologists classified each case according to the Shinoda staging system.

    Results Biopsy was recommended in 35.5–82.9%, partial resection in 6.6–32.9%, and GTR in 3.9–31.6% of cases. Agreement among their responses was fair (global kappa = 0.28). Nineteen patients were classified as stage I, 14 as stage II, and 43 as stage III. Agreement between the neurosurgeons and the recommendations of the staging system was poor for stage I (kappa = 0.14) and stage II (kappa = 0.02) and fair for stage III patients (kappa = 0.29). An individual analysis revealed that in contrast to the Shinoda system, neurosurgeons took into account T2/FLAIR sequences and gave greater weight to the involvement of eloquent areas.

    Conclusions The surgical approach to glioblastoma is highly variable. A staging system could be used to examine the impact of extent of resection, monitor post-operative complications, and stratify patients in clinical trials. Our findings suggest that the Shinoda staging system could be improved by including T2/FLAIR sequences and a more adequate weighting of eloquent areas.