Relationship between the extent of resection and the survival of patients with low-grade gliomas: a systematic review and meta-analysis

Abstract Background Optimum management of low-grade gliomas remains controversial, and widespread practice variation exists. This evidence-based meta-analysis evaluates the association of extent of resection, radiation, and chemotherapy with mortality and progression-free survival at 2, 5, and 10 years in patients with low-grade glioma. Methods A quantitative systematic review was performed. Inclusion criteria included controlled trials of newly diagnosed low-grade (World Health Organization Grades I and II) gliomas in adults. Eligible studies were identified, assigned a level of evidence for every endpoint considered, and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relative risk of mortality and of progression at 2, 5, and 10 years was calculated for patients undergoing resection (gross total, subtotal, or biopsy), radiation, or chemotherapy. Results Gross total resection was significantly associated with decreased mortality and likelihood of progression at all time points compared to subtotal resection. Early radiation was not associated with decreased mortality; however, progression-free survival was better at 5 years compared to patients receiving delayed or no radiation. Chemotherapy was associated with decreased mortality at 5 and 10 years in the high-quality literature. Progression-free survival was better at 5 and 10 years compared to patients who did not receive chemotherapy. In patients with isocitrate dehydrogenase 1 gene (IDH1) R132H mutations receiving chemotherapy, progression-free survival was better at 2 and 5 years than in patients with IDH1 wild-type gliomas. Conclusions Results from this review, the first to quantify differences in outcome associated with surgery, radiation, and chemotherapy in patients with low-grade gliomas, can be used to inform evidence-based management and future clinical trials.

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Amide proton transfer-weighted MRI in distinguishing high- and low-grade gliomas: a systematic review and meta-analysis

Neuroradiology ◽

10.1007/s00234-018-02152-2 ◽

2019 ◽

Vol 61 (5) ◽

pp. 525-534 ◽

Cited By ~ 10

Author(s):

Chong Hyun Suh ◽

Ji Eun Park ◽

Seung Chai Jung ◽

Choong Gon Choi ◽

Sang Joon Kim ◽

...

Keyword(s):

Systematic Review ◽

Proton Transfer ◽

Meta Analysis ◽

Amide Proton ◽

Low Grade ◽

Low Grade Gliomas ◽

Amide Proton Transfer

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Clinical characteristics associated with postoperative seizure control in adult low-grade gliomas: a systematic review and meta-analysis

Neuro-Oncology ◽

10.1093/neuonc/nox130 ◽

2017 ◽

Vol 20 (3) ◽

pp. 324-331 ◽

Cited By ~ 6

Author(s):

Xia Shan ◽

Xing Fan ◽

Xing Liu ◽

Zheng Zhao ◽

Yinyan Wang ◽

...

Keyword(s):

Systematic Review ◽

Clinical Characteristics ◽

Seizure Control ◽

Meta Analysis ◽

Low Grade ◽

Low Grade Gliomas ◽

Postoperative Seizure

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The Prevalence of BRAF Mutations in Patients with Glioma: A Systematic Review

Neuro-Oncology ◽

10.1093/neuonc/noz167.056 ◽

2019 ◽

Vol 21 (Supplement_4) ◽

pp. iv13-iv13

Author(s):

Saanwalshah Samir Saincher ◽

Julian P T Higgins ◽

Alexandra McAleenan ◽

Kathreena M Kurian

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Age Groups ◽

Low Grade ◽

Braf Inhibitors ◽

Braf Mutations ◽

Low Grade Gliomas ◽

Promising Area ◽

Oncogene Homologue ◽

Murine Sarcoma

Abstract Background The V600mutation in the v-raf murine sarcoma oncogene homologue B1 (BRAF) enzyme, is a potential clinically actionable target in gliomas. BRAF inhibitors are in wide clinical use for other tumour types, particularly melanoma. The prevalence of this mutation across all gliomas is not fully elucidated and is needed to inform potential screening and treatment. Methods A systematic review using articles on the MEDLINE and EMBASE databases (February 1, 2019) was carried out. A meta-analysis was conducted to calculate the prevalence of BRAF mutations in patients with gliomas across all populations and age groups in a clinical setting. Preliminary Results The review identified 75 studies including 6316 patients; the ages of participants ranged from 30 days to 90 years with a mean age of 32.75 years. Across all studies, the average prevalence of BRAF mutations was 16% (95% confidence interval (CI) from 12% to 20%) but estimates were highly variable across studies, ranging from 0% to 78%. The average prevalence of BRAF mutations in paediatric group was 15% (95% CI 10% to 20%) while the average prevalence in the adult group was 9% (95% CI 4% to 16%). Low grade gliomas had an average prevalence of 19% (95% CI 14% to 25%) compared with 7% (95% CI 4% to 11%) in high-grade gliomas. Conclusions BRAF mutations were found to be more prevalent in pediatric patients and in low grade gliomas. Screening these patients for BRAF mutations and treating them with BRAF inhibitors represents a promising area of future medical practice.

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Extent of resection in diffuse low-grade gliomas and the role of tumor molecular signature—a systematic review of the literature

Neurosurgical Review ◽

10.1007/s10143-020-01362-8 ◽

2020 ◽

Cited By ~ 1

Author(s):

Lucas Alverne F. Albuquerque ◽

João Paulo Almeida ◽

Leonardo José Monteiro de Macêdo Filho ◽

Andrei F. Joaquim ◽

Hugues Duffau

Keyword(s):

Systematic Review ◽

Extent Of Resection ◽

Molecular Signature ◽

Low Grade ◽

Review Of The Literature ◽

Low Grade Gliomas

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Association of aggressive resection with survival and progression-free survival in adult low-grade glioma: A systematic review and meta-analysis with numbers needed to treat.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.2025 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 2025-2025 ◽

Cited By ~ 1

Author(s):

Timothy J Brown ◽

Daniela Annenelie Bota ◽

Elizabeth A. Maher ◽

Dawit Gebremichael Aregawi ◽

Linda M. Liau ◽

...

Keyword(s):

Systematic Review ◽

Prospective Studies ◽

Meta Analysis ◽

Progression Free Survival ◽

Extent Of Resection ◽

The Body ◽

Subtotal Resection ◽

Low Grade ◽

Free Survival ◽

Numbers Needed To Treat

2025 Background: Low-grade gliomas (LGG) account for 17-22% of all primary brain tumors. Optimal surgical management consists of optimum safe resection with the goal of complete resection. We performed a systematic review and meta-analysis to quantify the association of extent of resection with likelihood of survival, expressing our results in numbers needed to treat (NNT). Methods: A systematic review and study-level meta-analysis to determine the association of resection with overall survival and progression-free survival in newly diagnosed, supratentorial LGG in adults was performed by querying PubMed. Data were extracted to compare gross total resection (GTR) to subtotal resection (STR) and STR to biopsy (Bx) to determine relative risks (RR) of death and progression at 2, 5, and 10 years. Data were analyzed using a random effects model. NNT were calculated from significant comparisons and rounded up to the nearest whole number. Quality of evidence was determined by American Academy of Neurology criteria. Results: The systematic review resulted in 283 potential studies. Ultimately 29 studies were included in at least one comparison. There were no high quality (class I and II) or prospective studies discovered in the review. Comparing GTR to STR, RR with 95% confidence intervals (CI) of death at 2, 5, and 10 years, and NNT to avoid one death at 2, 5, and 10 years (GTR vs. STR) were 0.29 [0.17-0.52, p < 0.0001, NNT 17], 0.39 [0.29-0.51, p < 0.00001, NNT 6], and 0.50 [0.35-0.70, p < 0.0001 NNT 4]. RR and NNT for progression (GTR vs. STR) at 2, 5, and 10 years were 0.37 [0.24-0.57, p < 0.0001 NNT 7], 0.50 [0.39-0.64, p < 0.0001 NNT 4], and 0.67 [0.53-0.84, p = 0.0005 NNT 4]. Comparing STR to Bx, RR of death at 2, 5, and 10 years were 0.55 [0.34-0.88, p = 0.01 NNT 10], 0.9 [0.61-1.34], and 0.95 [0.73-1.23]. Conclusions: Increasing resection thresholds appear to be associated with improved overall and progression free survival, but the body of literature consists of low quality studies. Prospective studies are required to explore whether extent of resection matters or whether resectable tumors share a favorable biology associated with better outcome.

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Awake craniotomy for resection of supratentorial glioblastoma: a systematic review and meta-analysis

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa111 ◽

2020 ◽

Vol 2 (1) ◽

Author(s):

John J Y Zhang ◽

Keng Siang Lee ◽

Mathew R Voisin ◽

Shawn L Hervey-Jumper ◽

Mitchel S Berger ◽

...

Keyword(s):

Systematic Review ◽

Tumor Volume ◽

Meta Analysis ◽

Extent Of Resection ◽

Neurological Complications ◽

Awake Craniotomy ◽

Neurological Deficits ◽

Current Evidence ◽

Low Grade ◽

Ovid Medline

Abstract Background The goal of glioblastoma (GBM) surgery is to maximize the extent of resection (EOR) while minimizing postoperative neurological complications. Awake craniotomy (AC) has been demonstrated to achieve this goal for low-grade gliomas in or near eloquent areas. However, the efficacy of AC for GBM resection has not been established. Therefore, we aimed to investigate the outcomes of AC for surgical resection of GBM using a systematic review and meta-analysis of published studies. Methods Systematic searches of Ovid MEDLINE, Embase, Cochrane Controlled Register of Controlled Trials, and PubMed were performed from database inception to September 14, 2019 for published studies reporting outcomes of AC for GBM resection. Outcome measures analyzed included EOR and the event rate of postoperative neurological deficits. Results A total of 1928 unique studies were identified. Fourteen studies reporting 278 patients were included in our meta-analysis. Mean age of patients was 46.9 years (95% confidence interval [CI]: 43.9–49.9). Early and late postoperative neurological deficits occurred in 34.5% (95% CI: 21.9–48.2) and 1.9% (95% CI: 0.0–9.2) of patients, respectively. Pooled percentage of gross total resection (GTR) was 74.7% (95% CI: 66.7–82.1), while the pooled percentage reduction in tumor volume was 95.3% (95% CI: 92.2–98.4). Conclusions Limited current evidence suggests that the use of AC for resection of supratentorial GBM is associated with a low rate of persistent neurological deficits while achieving an acceptable rate of GTR. Our findings demonstrate the potential viability of AC in GBM resection and highlight the need for further research on this topic.

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The diagnostic performance of magnetic resonance spectroscopy in differentiating high-from low-grade gliomas: A systematic review and meta-analysis

European Radiology ◽

10.1007/s00330-015-4046-z ◽

2015 ◽

Vol 26 (8) ◽

pp. 2670-2684 ◽

Cited By ~ 40

Author(s):

Qun Wang ◽

Hui Zhang ◽

JiaShu Zhang ◽

Chen Wu ◽

WeiJie Zhu ◽

...

Keyword(s):

Systematic Review ◽

Magnetic Resonance ◽

Magnetic Resonance Spectroscopy ◽

Diagnostic Performance ◽

Meta Analysis ◽

Resonance Spectroscopy ◽

Low Grade ◽

Low Grade Gliomas

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Role of diffusional kurtosis imaging in grading of brain gliomas: A diagnostic test accuracy systematic review and meta-analysis

Neuro-Oncology ◽

10.1093/neuonc/noz167.050 ◽

2019 ◽

Vol 21 (Supplement_4) ◽

pp. iv12-iv12

Author(s):

Gehad Abdalla ◽

Eser Sanverdi ◽

Pedro M Machado ◽

Joey S W Kwong ◽

Jasmina Panovska-Griffiths ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Test Accuracy ◽

Low Grade ◽

Moderate Degree ◽

Diffusional Kurtosis Imaging ◽

Low Grade Gliomas ◽

Effect Model

Abstract Aim and objectives We aim to illustrate the diagnostic performance of diffusional kurtosis imaging (DKI) in the diagnosis of gliomas. Methods and materials A review protocol was developed according to the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P), registered in the international prospective register of systematic reviews, PROSPERO and published. Literature search in 4 databases was performed using the keywords “glioma” and “diffusional kurtosis”.After applying a robust inclusion/exclusion criteria, included articles were independently evaluated according to the QUADAS-2 tool.Data extraction was done in a pre-designed pro forma.Reported sensitivities and specificities were used to construct 2x2 tables and paired forest plots using the Review Manager (RevMan®) software.Random-effect model was pursued using the hierarchical summary receiver operator characteristics. Results Initially, 216 hits were retrieved. Considering duplicates and inclusion criteria; 23 articles were eligible for full-text reading. Ultimately, 19 studies were deemed to be eligible for final inclusion. Quality assessment revealed 9 studies with low risk of bias in the 4 domains. Using a bivariate random-effect model for data synthesis; summary ROC curve showed pooled area under the curve (AUC) of 0.92 and estimated sensitivity of 0.87 (95% CI: 0.78 - 0.92) in high/low grade gliomas’ differentiation.A mean difference in Mean Kurtosis (MK) value between HGG and LGG of 0.22 [95% CI: 0.25 - 0.19] was illustrated (p value = 0.0014) and a moderate degree of heterogeneity (I²= 73.8%). Conclusion DKI shows good diagnostic accuracy in high/low grade gliomas’ differentiation; which might qualify it to be part of the routine clinical practice, however; further evidence is deemed for technique standardization.

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