Commentary: Impact of Intraoperative Magnetic Resonance Imaging and Other Factors on Surgical Outcomes for Newly Diagnosed Grade II Astrocytomas and Oligodendrogliomas: A Multicenter Study

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. E29-E30
Author(s):  
Jan Coburger
Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 63-73 ◽  
Author(s):  
Alexander T Yahanda ◽  
Bhuvic Patel ◽  
Amar S Shah ◽  
Daniel P Cahill ◽  
Garnette Sutherland ◽  
...  

Abstract BACKGROUND Few studies use large, multi-institutional patient cohorts to examine the role of intraoperative magnetic resonance imaging (iMRI) in the resection of grade II gliomas. OBJECTIVE To assess the impact of iMRI and other factors on overall survival (OS) and progression-free survival (PFS) for newly diagnosed grade II astrocytomas and oligodendrogliomas. METHODS Retrospective analyses of a multicenter database assessed the impact of patient-, treatment-, and tumor-related factors on OS and PFS. RESULTS A total of 232 resections (112 astrocytomas and 120 oligodendrogliomas) were analyzed. Oligodendrogliomas had longer OS (P < .001) and PFS (P = .01) than astrocytomas. Multivariate analyses demonstrated improved OS for gross total resection (GTR) vs subtotal resection (STR; P = .006, hazard ratio [HR]: .23) and near total resection (NTR; P = .02, HR: .64). GTR vs STR (P = .02, HR: .54), GTR vs NTR (P = .04, HR: .49), and iMRI use (P = .02, HR: .54) were associated with longer PFS. Frontal (P = .048, HR: 2.11) and occipital/parietal (P = .003, HR: 3.59) locations were associated with shorter PFS (vs temporal). Kaplan-Meier analyses showed longer OS with increasing extent of surgical resection (EOR) (P = .03) and 1p/19q gene deletions (P = .02). PFS improved with increasing EOR (P = .01), GTR vs NTR (P = .02), and resections above STR (P = .04). Factors influencing adjuvant treatment (35.3% of patients) included age (P = .002, odds ratio [OR]: 1.04) and EOR (P = .003, OR: .39) but not glioma subtype or location. Additional tumor resection after iMRI was performed in 105/159 (66%) iMRI cases, yielding GTR in 54.5% of these instances. CONCLUSION EOR is a major determinant of OS and PFS for patients with grade II astrocytomas and oligodendrogliomas. Intraoperative MRI may improve EOR and was associated with increased PFS.


Author(s):  
Li-Li Xie ◽  
Zhi-Hong Xu ◽  
Deng-Hui Wei ◽  
Chun-Sen Xu

IntroductionThe use of preoperative Magnetic Resonance Imaging (MRI) in newly diagnosed breast cancer has been increasing. However, the value of MRI applied to the women with newly diagnosed breast cancer remains controversial. Therefore, this study focused on the association between preoperative MRI and surgical outcomes, which include mastectom y rate, breast conservation rate, and re-excision rate.Material and methodsA systematic literature search was performed by the Wan fang, VIP (Chinese biomedical databases), PubMed, Cochrane Library, Embase, and Vip databases. The keywords were "breast cancer", "magnetic resonance imaging", "mastectomy rate", "re-excision rate", and "breast conservation rate." A random-effects model was used to estimate the proportion of women with various outcomes in the MRI group, versus a non-MRI group. The odds ratio (OR) for each surgical outcome were calculated.Results4 RCTs (Randomized Controlled Trial) met the eligibility criteria that included a total of 2312 patients with breast cancer. The analysis results of the MRI group versus the non-MRI group were as follows: Mastectomy rate of 15% versus 10%, OR 2.01, 95% CI 0.79-5.11, P=0.14; Breast conservation rate 84% versus 89%, OR 0.58, 95% CI 0.29-1.17, P=0.13; Re-excision rate 17% versus 19%, OR 0.76, 95% CI 0.37-1.54, P=0.45.ConclusionsThere was no significant association between preoperative MRI and surgical outcomes. This study suggested that the use of preoperative MRI should be selective. The results showed that the application of preoperative MRI didn’t improve the prognosis of breast cancer patients. More randomized trials are needed for further study due to limited randomized trials.


Sign in / Sign up

Export Citation Format

Share Document