Cytoreductive surgery in the management of newly diagnosed glioblastoma in adults: a systematic review and evidence-based clinical practice guideline update

Joseph S. Domino, D. Ryan Ormond, Isabelle M. Germano, Mairaj Sami, Timothy C. Ryken, Jeffrey J. Olson

Research output: Contribution to journalReview articlepeer-review

12 Scopus citations

Abstract

Target population: These recommendations apply to adults with newly diagnosed or suspected glioblastoma. Question: What is the effect of extent of surgical resection on patient outcome in the initial management of adult patients with suspected newly diagnosed glioblastoma? Recommendation: Level II: Maximal cytoreductive surgery is recommended in adult patients with suspected newly diagnosed supratentorial glioblastoma with gross total resection defined as removal of contrast enhancing tumor. Level III: Biopsy, subtotal resection, or gross total resection is suggested depending on medical comorbidities, functional status, and location of tumor if maximal resection may cause significant neurologic deficit. Question: What is the role of cytoreductive surgery in adults with newly diagnosed bi-frontal “butterfly” glioblastoma? Recommendation: Level III: Resection of newly diagnosed bi-frontal “butterfly” glioblastoma is suggested to improve overall survival over biopsy alone. Question: What is the goal of cytoreductive surgery in elderly adult patients with newly diagnosed glioblastoma? Recommendation: Level III: Elderly patients (> 65 years) show survival benefit with gross total resection and it is suggested they undergo cytoreductive surgery. Question: What is the role of advanced intraoperative guidance techniques in cytoreductive surgery in adults with newly diagnosed glioblastoma? Recommendation: Level III: The use of intraoperative guidance adjuncts such as intraoperative MRI (iMRI) or 5-aminolevulinic acid (5-ALA) are suggested to maximize extent of resection in newly diagnosed glioblastoma. There is insufficient evidence to make a suggestion on the use of fluorescein, indocyanine green, or intraoperative ultrasound.

Original languageEnglish
Pages (from-to)121-142
Number of pages22
JournalJournal of Neuro-Oncology
Volume150
Issue number2
DOIs
StatePublished - Nov 2020

Keywords

  • Cytoreduction
  • Glioblastoma
  • Guideline
  • Surgery

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