scholarly journals Neoadjuvant chemotherapy reduces blood loss during the resection of pediatric choroid plexus carcinomas

2015 ◽  
Vol 16 (2) ◽  
pp. 126-133 ◽  
Author(s):  
Christian Schneider ◽  
Ian Kamaly-Asl ◽  
Vijay Ramaswamy ◽  
Lucie Lafay-Cousin ◽  
Abhaya V. Kulkarni ◽  
...  
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Blood Loss ◽  
Choroid Plexus ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Intraoperative Blood Loss ◽  
Total Resection ◽  
Sick Children ◽  
Choroid Plexus Carcinomas

OBJECT Choroid plexus carcinomas (CPCs) are rare brain tumors originating from the ventricular choroid plexus. They account for 2%–4% of all pediatric brain tumors and are most frequently seen in very young children. This pediatric proclivity, in combination with a marked vascularity, renders an aggressive resection a difficult and often dangerous endeavor. Blood losses of several total blood volumes in small children are not uncommon, sometimes forcing the neurosurgeon to abort the procedure, often leaving residual tumor. Great extent of tumor resection is an accepted beneficial factor for overall survival. Therefore, a second resection usually follows the administration of adjuvant chemotherapy. Second-look surgery appears to be associated with markedly decreased blood loss. Histological examination of specimens obtained at a second intervention shows decreased vascularity and fibrotic changes in tumor tissue. At the Hospital for Sick Children in Toronto, this empirical finding led to the strategy of neoadjuvant chemotherapy to minimize blood loss and maximize cytoreduction. The authors undertook this study to assess the potentially beneficial effect of neoadjuvant chemotherapy on blood loss during surgery for CPCs. METHODS In this retrospective cohort review, the demographic, clinical, and treatment parameters of 22 consecutive patients diagnosed with CPC are presented. All underwent surgical treatment at the Hospital for Sick Children from 1982 to 2013. Special attention was given to the impact of neoadjuvant chemotherapy on extent of resection and intraoperative blood loss. Extent of resection was calculated based on perioperative neuroimaging, and amount of blood loss was estimated based on transfusion parameters and perioperative changes in hematocrit. RESULTS Ten patients did not receive neoadjuvant chemotherapy, and 12 were treated with 2–5 cycles of ICE (ifosfamide, carboplatin, etoposide) chemotherapy in a neoadjuvant fashion. The 22 patients included in the study underwent a total of 37 tumor resection surgeries. In all of the cases in which neoadjuvant chemotherapy was used, at least a near-total resection (> 95% of tumor volume) was achieved. Patients who underwent gross-total resection had prolonged overall survival. Of the 37 resections, 18 were performed after chemotherapy. Mean blood loss in the neoadjuvant chemotherapy group was 22% of total estimated blood volume as opposed to 96% in patients without preoperative chemotherapy. CONCLUSIONS In children with CPC, the administration of neoadjuvant chemotherapy decreases intraoperative blood loss and increases extent of resection with a significant positive effect on overall survival.

Resection of infantile brain tumors after neoadjuvant chemotherapy: the St. Jude experience

2011 ◽  
Vol 8 (3) ◽  
pp. 251-256 ◽  
Author(s):  
Mark Van Poppel ◽  
Paul Klimo ◽  
Mariko Dewire ◽  
Robert A. Sanford ◽  
Frederick Boop ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Brain Tumors ◽  
Blood Loss ◽  
Subtotal Resection ◽  
Close Monitoring ◽  
Intraoperative Blood Loss ◽  
Tumor Vascularity ◽  
Total Resection ◽  
Second Look

Object Brain tumors in infants are often large, high grade, and vascular, making complete resection difficult and placing children at risk for neurological complications and excessive blood loss. Neoadjuvant chemotherapy may reduce tumor vascularity and volume, which can facilitate resection. The authors evaluated how an ongoing institutional prospective chemotherapy trial would affect patients who did not have a gross-total resection (GTR) immediately and who therefore required further surgical intervention to achieve definitive tumor resection. Methods Thirteen infants (4 girls and 9 boys) who were enrolled in an institutional protocol in which they were treated with multiagent chemotherapy (methotrexate, vincristine, cisplatin, and cyclophosphamide with vinblastine for high-risk patients) subsequently underwent second-look surgery. The primary outcome was extent of resection achieved in postchemotherapy surgery. Secondary outcomes included intraoperative blood loss, radiographic response to the chemotherapy, complications during chemotherapy, and survival. Results Three infants underwent biopsy, 9 underwent subtotal resection, and 1 patient did not undergo surgery prior to chemotherapy. On subsequent second-look surgery, 11 of 13 patients had a GTR, 1 had a near-total resection, and 1 had a subtotal resection. In each case, a marked reduction in tumor vascularity was observed intraoperatively. The average blood loss was 19% of estimated blood volume, and 6 (46%) of 13 patients required a blood transfusion. Radiographically, chemotherapy induced a reduction in tumor volume in 9 (69%) of 13 patients. Emergency surgery was required in 2 patients during chemotherapy, 1 for intratumoral hemorrhage and 1 for worsening peritumoral edema. The average follow-up period for this cohort was 16.5 months, and at last follow-up, 4 patients (31%) had died, 1 patient had progressive metastatic spinal disease, and the rest had either no evidence of disease or stable disease. Conclusions A GTR of pediatric brain tumors is one of the most important predictors of outcome. The application of the authors' neoadjuvant induction chemotherapy protocol in a variety of tumor types resulted in devascularization of all tumors and volume regression in the majority, and subsequently facilitated resection, with acceptable intraoperative blood loss. Intracranial complications may occur during chemotherapy, ranging from incidental and asymptomatic to life threatening, necessitating close monitoring of these children.

Giant Choroid Plexus Papilloma Resection Utilizing a Transcollation System

2019 ◽  
Vol 18 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Karam Asmaro ◽  
Jacob Pawloski ◽  
Jesse Skoch
Keyword(s):  
Blood Loss ◽  
Choroid Plexus ◽  
Tumor Resection ◽  
Choroid Plexus Papilloma ◽  
Normal Brain ◽  
Total Resection ◽  
Minimize Blood Loss ◽  
The Right ◽  
Plexus Papilloma ◽  
Children Under 5

Abstract BACKGROUND Large vascular brain tumors pose an exceptional challenge in young children. Choroid plexus papilloma (CPP) is an example of a rare, often large and especially vascular neuroepithelial tumor that most commonly arises in children under 5 yr old. Although patients may be cured by total resection, this tumor poses significant surgical risks and challenges related to intraoperative hemostasis. OBJECTIVE To describe our experience using a transcollation system during brain tumor surgery in a child to achieve hemostasis and minimize blood loss while preserving normal brain tissue. METHODS A 3-yr-old girl presented following a fall and was found to have a giant CPP growing from the right lateral ventricle. Given the vascularity of the tumor and the low intravascular reserve in a small child, a transcollation device was used to reduce blood loss intraoperatively. RESULTS Gross total resection was achieved with approximately 300 mL of blood loss without complications. The patient did well postoperatively. Imaging performed at 3 mo after resection revealed return of normal brain architecture. CONCLUSION Transcollation devices appear to be an effective and safe addition to the armamentarium of neurosurgical hemostatic options in intracranial tumor resection in which there is a high risk of intraoperative hemorrhage.

scholarly journals Safety of laparoscopic pancreaticoduodenectomy in patients with liver cirrhosis using propensity score matching

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0246364
Author(s):  
Ke Cheng ◽  
Wei Liu ◽  
Jiaying You ◽  
Shashi Shah ◽  
Yunqiang Cai ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Cirrhosis ◽  
Blood Loss ◽  
Postoperative Morbidity ◽  
Control Group ◽  
Complication Rates ◽  
Laparoscopic Pancreaticoduodenectomy ◽  
Intraoperative Blood Loss ◽  
Cirrhotic Patients

Currently, safety of laparoscopic pancreaticoduodenectomy (LPD) in patients with liver cirrhosis is unknown. The aim of this study was to explore postoperative morbidity and mortality and long-term outcomes of cirrhotic patients after LPD. The study was a one-center retrospective study comprising 353 patients who underwent LPD between October 2010 and December 2019. A total of 28 patients had liver cirrhosis and were paired with 56 non-cirrhotic counterparts through propensity score matching (PSM). Baseline data, intra-operative data, postoperative data, and survival data were collected. Postoperative morbidity was considered as primary outcome whereas postoperative mortality, surgical parameters (operative durations, intraoperative blood loss), and long-term overall survival were secondary outcomes. Cirrhotic patients showed postoperative complication rates of 82% compared with rates of patients in the control group (48%) (P = 0.003). Further, Clavien-Dindo ≥III complication rates of 14% and 11% (P = 0.634), Clavien-Dindo I-II complication rates of 68% and 38% (P = 0.009), hospital mortality of 4% and 2% (P = 0.613) were observed for cirrhotic patients and non-cirrhotic patients, respectively. In addition, an overall survival rate of 32 months and 34.5 months (P = 0.991), intraoperative blood loss of 300 (200–400) ml and 150 (100–250) ml (P<0.0001), drain amount of 2572.5 (1023.8–5275) ml and 1617.5 (907.5–2700) ml (P = 0.048) were observed in the cirrhotic group and control group, respectively. In conclusion, LPD is associated with increased risk of postoperative morbidity in patients with liver cirrhosis. However, the incidence of Clavien-Dindo ≥III complications and post-operative mortality showed no significant increase. In addition, liver cirrhosis showed no correlation with poor overall survival in patients who underwent LPD. These findings imply that liver cirrhosis patients can routinely be considered for LPD at high volume centers with rigorous selection and management.

Preoperative evaluation of intraoperative blood loss during malignant soft tissue tumor resection by ultrasonography

2018 ◽  
Vol 23 (2) ◽  
pp. 403-407 ◽  
Author(s):  
Takeshi Morii ◽  
Tomonori Kishino ◽  
Naoko Shimamori ◽  
Mitsue Motohashi ◽  
Hiroaki Ohnishi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Blood Loss ◽  
Soft Tissue Tumor ◽  
Preoperative Evaluation ◽  
Tumor Resection ◽  
Intraoperative Blood Loss ◽  
Tissue Tumor ◽  
Malignant Soft Tissue Tumor ◽  
Malignant Soft Tissue

Lymphatic Leakage after Surgery for Neuroblastoma: A Rare Complication?

2020 ◽  
Author(s):  
Alexandra Froeba-Pohl ◽  
Jakob Muehling ◽  
Katharina Vill ◽  
Veit Grote ◽  
Tim Komm ◽  
...  
Keyword(s):  
Overall Survival ◽  
Rare Complication ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Mycn Amplification ◽  
Study Cohort ◽  
Common Complication ◽  
Lymphatic Duct ◽  
Extent Of Surgery

Abstract Introduction Neuroblastoma is the most common extracranial solid tumor in infancy. It is responsible for around 15% of all oncological deaths during childhood. Due to its retroperitoneal location, neuroblastoma is invasively growing directly in and around the lymphatic duct. Consecutively, lymphatic leakage (LL) after surgery for neuroblastoma is a known complication. The purpose of this study is the investigation of frequency and impact of this complication. Material and Methods Between February 2003 and December 2016, 204 patients with neuroblastoma received surgical treatment in our department. A retrospective analysis for macroscopical extent of resection, duration of drainage postsurgery, maximum amount of fluid drained in 24 hours, MYCN amplification status, therapeutic options for LL, follow-up status, and overall survival was performed. Results A total of 40% of patients (82/204) showed LL to some extent. In patients with MYCN amplification, LL was seen significantly more often than in patients without MYCN amplification status (p = 0.019). LL was also significantly correlated with extent of surgery (p = 0.005). Follow-up status and overall survival were significantly inversely associated with LL (p = 0.004 and p = 0.0001). LL was self-limiting in all cases. There was a trend toward shorter duration of LL if either no special therapy was chosen or total parenteral nutrition (TPN) was administered (p = 0.0603). Conclusion We show that LL in neuroblastoma is a common complication of tumor resection and occurring more often than anticipated. Since, in our study cohort, all cases of LL were self-limiting, we question the indication for invasive therapy besides supporting measures.

scholarly journals Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter?

2012 ◽  
Vol 33 (3) ◽  
pp. E16 ◽  
Author(s):  
Richard K. Gurgel ◽  
Salim Dogru ◽  
Richard L. Amdur ◽  
Ashkan Monfared
Keyword(s):  
Facial Nerve ◽  
Surgical Approach ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Vestibular Schwannomas ◽  
Surgical Approaches ◽  
Subtotal Resection ◽  
Total Resection ◽  
Translabyrinthine Approach ◽  
Better Than

Object The object of this study was to evaluate facial nerve outcomes in the surgical treatment of large vestibular schwannomas (VSs; ≥ 2.5 cm maximal or extrameatal cerebellopontine angle diameter) based on both the operative approach and extent of tumor resection. Methods A PubMed search was conducted of English language studies on the treatment of large VSs published from 1985 to 2011. Studies were then evaluated and included if they contained data regarding the size of the tumor, surgical approach, extent of resection, and postoperative facial nerve function. Results Of the 536 studies initially screened, 59 full-text articles were assessed for eligibility, and 30 studies were included for analysis. A total of 1688 tumor resections were reported. Surgical approach was reported in 1390 patients and was significantly associated with facial nerve outcome (ϕ= 0.29, p < 0.0001). Good facial nerve outcomes (House-Brackmann Grade I or II) were produced in 62.5% of the 555 translabyrinthine approaches, 65.2% of the 601 retrosigmoid approaches, and 27.4% of the 234 extended translabyrinthine approaches. Facial nerve outcomes from translabyrinthine and retrosigmoid approaches were not significantly different from each other, but both showed significantly more good facial nerve outcomes, compared with the extended translabyrinthine approach (OR for translabyrinthine vs extended translabyrinthine = 4.43, 95% CI 3.17–6.19, p < 0.0001; OR for retrosigmoid vs extended translabyrinthine = 4.98, 95% CI 3.57–6.95, p < 0.0001). There were 471 patients for whom extent of resection was reported. There was a strong and significant association between degree of resection and outcome (ϕ= 0.38, p < 0.0001). Of the 80 patients receiving subtotal resections, 92.5% had good facial nerve outcomes, compared with 74.6% (n = 55) and 47.3% (n = 336) of those who received near-total resections and gross-total resections, respectively. In the 2-way comparison of good versus suboptimal/poor outcomes (House-Brackmann Grade III–VI), subtotal resection was significantly better than near-total resection (OR = 4.21, 95% CI 1.50–11.79; p = 0.004), and near-total resection was significantly better than gross-total resection (OR = 3.26, 95% CI 1.71–6.20; p = 0.0002) in producing better facial nerve outcomes. Conclusions In a pooled patient population from studies evaluating the treatment of large VSs, subtotal and near-total resections were shown to produce better facial nerve outcomes when compared with gross-total resections. The translabyrinthine and retrosigmoid surgical approaches are likely to result in similar rates of good facial nerve outcomes. Both of these approaches show better facial nerve outcomes when compared with the extended translabyrinthine approach, which is typically reserved for especially large tumors. The reported literature on treatment of large VSs is extremely heterogeneous and minimal consistency in reporting outcomes was observed.

Does extent of resection of glioblastoma multiforme affect survival?

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14514-e14514
Author(s):  
Emad Eldin Nabil ◽  
Ashraf Elyamany
Keyword(s):  
Glioblastoma Multiforme ◽  
Eastern Cooperative Oncology Group ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Complete Resection ◽  
University Hospital ◽  
Gross Total Resection ◽  
Cancer Center ◽  
Total Resection ◽  
Imaging Results

e14514 Background: Glioblastoma Multiforme (GBM) is the most common primary intracranial tumor. The effect on survival of extent of tumor resection for GBM tumors remains controversial. Our study aims to detect the role of extent of tumor resection in improvement of survival in patients with GBM. Methods: A prospective study for 84 patients with GBM, was conducted between March 2013 and September 2016 in Sohag University Hospital and Sohag Cancer Center. For all of them surgery was done. Either biopsy (stereotactic or open), debulking or gross total resection (complete). All patients received radical radiotherapy concurrent with Temozolomide chemotherapy followed by six to eight cycles of Temozolomide. All patients were followed by clinical examination and brain imaging. Results: 59% of our patients were males and 41% were females. About 78% of the patients had either Eastern Cooperative Oncology Group (ECOG) Performance Status 1 or 2. Median age was 51years with a range (25-70 years). In 38 patients (45.8%) debulking was done, while complete resection was done in 20 patients (24.1%). only biopsy was done in 30% of patients. We found a statistically significant effect for the extent of resection on overall survival (OS)(22 vs 19.5 months) and progression free survival (PFS)(18.25 vs17.42 months) for patients with complete resection vs patients with debulking only. In addition younger age patients had a statistically significant longer survival. Conclusions: Gross total resection (complete resection) of intracranial GBM was associated with longer survival. Gross total resection should be performed whenever possible.

Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children's Cancer Group Trial No. CCG-945

1998 ◽  
Vol 89 (1) ◽  
pp. 52-59 ◽  
Author(s):  
Jeffrey H. Wisoff ◽  
James M. Boyett ◽  
Mitchel S. Berger ◽  
Catherine Brant ◽  
Hao Li ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Posterior Fossa ◽  
Anaplastic Astrocytoma ◽  
Tumor Resection ◽  
Radical Resection ◽  
Extent Of Resection ◽  
Total Resection ◽  
Content Type ◽  
Cancer Group ◽  
Fine Print

Object. One hundred seventy-two children with high-grade astrocytomas were treated by members of the Children's Cancer Group in a prospective randomized trial designed to evaluate the role of two chemotherapy regimens. Seventy-six percent of the patients (131 children) in whom a diagnosis of either anaplastic astrocytoma or glioblastoma multiforme was confirmed by central pathological review are the subject of this report. Methods. Patients were stratified according to the extent of tumor resection (biopsy [< 10%], partial resection [10–50%], subtotal resection [51–90%], near-total resection [> 90%], and total resection) as determined by surgical observation and postoperative computerized tomography scanning. Information on contemporary neurosurgical management was obtained from the patient's operative records and standardized neurosurgical report forms. The vast majority of tumors were supratentorial: 63% (83 tumors) in the superficial cerebral hemisphere, 28% (37 tumors) in the deep or midline cerebrum, and only 8% (11 tumors) in the posterior fossa. A significant association was detected between the primary tumor site and the extent of resection (p < 0.0001). A radical resection (> 90%) was performed in 37% of the children: 49% of the tumors in the superficial hemisphere and 45% of tumors in the posterior fossa compared with 8% of midline tumors. Tumor location could also be used to predict the need for both temporary and permanent cerebrospinal fluid (CSF) diversion. Half of the deep tumors and 8% of the hemispheric astrocytomas ultimately required a permanent CSF shunt. Improvement in preoperative neurological deficits and level of consciousness was seen in 36% and 34% of the children, respectively. New or increased deficits were present in 14% of the children, with 6% experiencing a diminished sensorium after surgery. Postoperative nonneurological complications were rare: infection, hematoma, and CSF fistula each occurred in 1.7% of the children. Univariate and multivariate analyses demonstrated that radical tumor resection (> 90%) was the only therapeutic variable that significantly improved progression-free survival (PFS) rates. For all patients with malignant astrocytomas, the distributions of PFS rates were significantly different (p = 0.006) following radical resection compared with less extensive (< 90%) resection. The 5-year PFS rates were 35 ± 7% and 17 ± 4%, respectively. The differences in the distribution of PFS rate were significant for the subsets of patients with anaplastic astrocytoma (p = 0.055) and glioblastoma multiforme (p = 0.046). The 5-year PFS rates for anaplastic astrocytoma were 44 ± 11% and 22 ± 6% for cases in which the tumor was radically resected and less than radically resected, respectively; whereas the 5-year PFS rates for glioblastoma multiforme were 26 ± 9% and 4 ± 3% for cases in which the tumor was radically resected and less than radically resected, respectively. Conclusions. The demonstration of a survival advantage provided by radical resection should prompt neurosurgeons to treat malignant pediatric astrocytomas with aggressive surgical resection prior to initiation of radiotherapy or adjuvant chemotherapy.

scholarly journals 3D-printed Prostheses Assisted by Osteotomy Guide Plates for Reconstruction Following Periacetabular Tumor Resection via Two Approaches

2021 ◽  
Author(s):  
Yong-jie Zhao ◽  
Jing-yu Zhang ◽  
Xiao-qiang Deng ◽  
Xin-chong Du ◽  
Hao Zhang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tumor Resection ◽  
Intraoperative Blood Loss ◽  
Musculoskeletal Tumor Society ◽  
Prosthetic Reconstruction ◽  
Operative Duration ◽  
Vas Score ◽  
Surgical Data ◽  
3D Printed ◽  
The Mean

Abstract Background: Prosthetic reconstruction after periacetabular tumor resection likely yield good function. However, complications with this technique are common. Therefore, alternative prosthetic design and surgical technique warrant study. Methods: Six patients were retrospectively reviewed with malignant periacetabular tumors who received reconstruction using 3D-printed prostheses assisted by osteotomy guide plates via two approaches between July 2017 and June 2020. The surgical data, including operative duration and intraoperative blood loss were recorded. Preoperative and postoperative pain at rest was examined using the visual analog scale (VAS). The postoperative functional outcomes were evaluated using the Musculoskeletal Tumor Society (MSTS) scoring system, and the postoperative complications were analyzed.Results: The mean follow-up was 19 months (range, 3-36 months). The mean intraoperative blood loss was 1416 ml (range, 600-2000 ml), and the mean operative duration was 333 min (range, 300-370 min). Satisfactory surgical margins were achieved in all patients. Six patients complained of severe pain preoperatively (VAS score, mean, 6; range, 4-8) and described significant alleviation of pain at 4 weeks postoperatively (VAS score, mean, 2; range, 0-5). At the 12 weeks after surgery, the mean MSTS score was 15.6 (range, 5-27). Local recurrence occurred in one patient at 3 months after surgery.Conclusions: The 3D-printed prosthesis represents a potential alternative for reconstruction after malignant periacetabular tumor resection. The design of the two approaches and the use of osteotomy guide plates can yield good functional results, as well as low rate of complications.Trial registration: This study has been granted an exemption from requiring ethics approval by the ethics committee of Tianjin Hospital.

scholarly journals P14.116 Lack of correlation between incidental ipsilateral subventricular zone radiation dose and overall survival in glioblastoma patients

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii95-iii96
Author(s):  
G Hallaert ◽  
H Pinson ◽  
D Vanhauwaert ◽  
L Staelens ◽  
C Vandenbroecke ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Dose ◽  
Subventricular Zone ◽  
Cox Regression ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Karnofsky Performance Score ◽  
Mgmt Methylation ◽  
Gene Methylation ◽  
Total Resection

Abstract BACKGROUND The role of the subventricular zone (SVZ) in glioblastoma (GBM) is controversial. The past decade, several retrospective studies were published concerning the potential correlation between incidental radiation of the SVZ and survival in GBM patients. Although these publications showed conflicting results, a large study claimed an overall survival (OS) benefit for GBM patients after gross total resection if the ipsilateral SVZ received a higher dose than 40 Gy. We investigated this finding in our own population of GBM patients. MATERIAL AND METHODS A multicenter retrospective study was conducted including all adult patients treated for histologically proven GBM from 2003–2014. All patients received 60 Gy radiation therapy after surgery and concomitant temozolomide. Exclusion criteria were: infratentorial GBM; presence of other neoplasm(s); known previous history of low grade glioma; incomplete radiotherapy data. Demographic data were collected from the patient charts. O6-methylguanin-DNA-methyltransferase-promotor-gene (MGMT) methylation was determined on stored tumor samples using semi quantitative methylation-specific polymerase chain reaction (qMSP). SVZs (ipsilateral, contralateral and bilateral) were contoured on radiotherapy treatment plans. Multivariate Cox regression analysis was used to study the correlation between incidental SVZ radiation dose and OS. Age (cut-off 65 years), Karnofsky Performance Score (KPS; cut-off 70), methylation of the MGMT-promotor gene and extent of resection (biopsy; subtotal resection, groos total resection) were used as covariates. Patients alive at time of database closure were censored for analysis. RESULTS 183 patients were eligible for analysis. Mean age at diagnosis was 62 years, with an average KPS of 70. In 34% of patients, gross total resection (GTR) was achieved, while in 28% only a biopsy was taken. MGMT-promoter gene methylation was present in 39% of cases. Median ipsilateral, contralateral and bilateral SVZ doses were 46.1 Gy, 25.35 Gy and 34.8 Gy resp. In multivariate Cox regression, all covariates (age, P = 0.011; KPS, P = 0.001; MGMT methylation, P = 0.000; extent of resection, P = 0.000) were significantly associated with OS. Mean OS was 23 months, but median OS 13 months. There was no correlation between incidental radiation dose of the ipsilateral SVZ and OS for 46 Gy or 40 Gy (hazard ratio 0.82 (0.6–1.1), P = 0.225 and 0.89 (0.63–1.23), P = 0.52 resp.) for the whole group nor for the subgroup of gross total resection. CONCLUSION In this group of GBM patients, age, KPS, extent of resection and methylation of the MGMT-promotor gene were significantly correlated with OS, but not incidental ipsilateral SVZ radiation dose. The previously published positive results may result from bias, possibly arising from lack of inclusion of MGMT-promotor gene methylation as an important independent prognostic factor.

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