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Sinha S, Avnon A, Perera A, Lavrador JP, Ashkan K. Butterfly gliomas: a time for stratified management? Neurosurg Rev 2023; 46:223. [PMID: 37665387 PMCID: PMC10477135 DOI: 10.1007/s10143-023-02126-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/16/2023] [Accepted: 08/23/2023] [Indexed: 09/05/2023]
Abstract
Butterfly glioblastomas (bGBM) are a rare subset of WHO grade IV tumours that carry a poor prognosis with a median survival ranging between 3.3 to 6 months. Given their poor prognosis, there is debate over whether histological diagnosis with a biopsy or any surgical or oncological intervention alters disease progression. With this in mind, we reviewed our experience as a high-volume unit to evaluate management decisions and outcomes. A retrospective analysis was undertaken (January 2009 to June 2021) of the electronic patient records of a large neurosurgical centre. We assessed patient demographics, initial clinical presentation, tumour characteristics, clinical management and overall survival (Kaplan-Meier estimator, log-rank analysis and cox proportional hazard analysis). Eighty cases of bGBM were identified. These patients were managed with biopsy ± adjuvant therapy (36), with radiotherapy alone without biopsy (3), or through surgical resection (3). Thirty-eight cases of suspected bGBM were managed conservatively, receiving no oncological treatment or surgical resection/biopsy for histological diagnosis. Those managed conservatively and with radiotherapy without biopsy were diagnosed at neuro-oncology multidisciplinary meeting (MDT) based on clinical presentation and radiological imaging. No significant difference in survival was seen between conservative management compared with single adjuvant treatment (p = 0.69). However, survival was significantly increased when patients received dual adjuvant chemoradiotherapy following biopsy or resection (p = 0.002). A Cox Proportional Hazards model found that survival was significantly impacted by the oncology treatment (p < 0.001), but was not significantly related to potential confounding variables such as the patient's age (p = 0.887) or KPS (p = 0.057). Butterfly glioblastoma have a poor prognosis. Our study would suggest that unless a patient is planned for adjuvant chemoradiotherapy following biopsy, they should be managed conservatively. This avoids unnecessary procedural interventions with the associated morbidities and costs.
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Affiliation(s)
- Siddharth Sinha
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.
| | - Adam Avnon
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrea Perera
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
- Maurice Wohl institute, Kings College London, London, UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Boaro A, Kavouridis VK, Siddi F, Mezzalira E, Harary M, Iorgulescu JB, Reardon DA, Smith TR. Improved outcomes associated with maximal extent of resection for butterfly glioblastoma: insights from institutional and national data. Acta Neurochir (Wien) 2021; 163:1883-94. [PMID: 33871698 DOI: 10.1007/s00701-021-04844-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Butterfly glioblastomas (bGBMs) are grade IV gliomas that infiltrate the corpus callosum and spread to bilateral cerebral hemispheres. Due to the rarity of cases, there is a dearth of information in existing literature. Herein, we evaluate clinical and genetic characteristics, associated predictors, and survival outcomes in an institutional series and compare them to a national cohort. METHODS We identified all adult patients with bGBM treated at Brigham & Women's Hospital (2008-2018). The National Cancer Database (NCDB) was also queried for bGBM patients. Survival was analyzed with Kaplan-Meier methods, and Cox models were built to assess for predictive factors. RESULTS Of 993 glioblastoma patients, 62 cases (6.2%) of bGBM were identified. Craniotomy for resection was attempted in 26 patients (41.9%), with a median volumetric extent of resection (vEOR) of 72.3% (95% confidence interval [95%CI] 58.3-82.1). The IDH1 R132H mutation was detected in two patients (3.2%), and MGMT promoter was methylated in 55.5% of the assessed cases. In multivariable regression, factors predictive of longer OS were increased vEOR, MGMT promoter methylation, and receipt of adjuvant therapy. Median OS for the resected cases was 11.5 months (95%CI 7.7-18.8) vs. 6.3 (95%CI 5.1-8.9) for the biopsied. Of 21,353 GBMs, 719 (3.37%) bGBM patients were identified in the NCDB. Resection was more likely to be pursued in recent years, and GTR was independently associated with prolonged OS (p < 0.01). CONCLUSION Surgical resection followed by adjuvant chemoradiation is associated with significant survival gains and should be pursued in carefully selected bGBM patients.
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Franco P, Delev D, Cipriani D, Neidert N, Kellner E, Masalha W, Mercas B, Mader I, Reinacher P, Weyerbrock A, Fung C, Beck J, Heiland DH, Schnell O. Surgery for IDH1/2 wild-type glioma invading the corpus callosum. Acta Neurochir (Wien) 2021; 163:937-945. [PMID: 33095353 PMCID: PMC7966629 DOI: 10.1007/s00701-020-04623-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/16/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Glioblastoma of the corpus callosum (ccGBM) are rare tumors, with a dismal prognosis marked by a rapid clinical deterioration. For a long time, surgical treatment was not considered beneficial for most patients with such tumors. Recent studies claimed an improved survival for patients undergoing extensive resection, albeit without integration of the molecular profile of the lesions. The purpose of this study was to investigate the effect of biopsy and surgical resection on oncological and functional outcomes in patients with IDH wild-type ccGBM. METHODS We performed a retrospective analysis of our institution's database of patients having been treated for high-grade glioma between 2005 and 2017. Inclusion criteria were defined as follows: patients older than 18 years, histopathological, and molecularly defined IDH wild-type glioma, major tumor mass (at least 2/3) invading the corpus callosum in the sagittal plane with a uni- or bilateral infiltration of the adjacent lobules. Surgical therapy (resection vs. biopsy), extent of resection according to the remaining tumor volume and adjuvant treatment as well as overall survival and functional outcome using the Karnofsky Performance Score (KPS) were analyzed. RESULTS Fifty-five patients were included in the study, from which the mean age was 64 years and men (n = 34, 61.8%) were more often affected than women (n = 21, 38.2%). Thirty (54.5%) patients were treated with stereotactic biopsy alone, while 25 patients received tumor resection resulting in 14.5% (n = 8) gross-total resections and 30.9% (n = 17) partial resections. The 2-year survival rate after resection was 30% compared to 7% after biopsy (p = 0.047). The major benefit was achieved in the group with gross-total resection, while partial resection failed to improve survival. Neurological outcome measured by KPS did not differ between both groups either pre- or postoperatively. CONCLUSIONS Our study suggests that in patients with corpus callosum glioblastoma, gross-total resection prolongs survival without negatively impacting neurological outcome as compared to biopsy.
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Affiliation(s)
- Pamela Franco
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany.
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany.
| | - Daniel Delev
- Department of Neurosurgery, University of Aachen, Aachen, NRW, Germany
| | - Debora Cipriani
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
| | - Nicolas Neidert
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
| | - Elias Kellner
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
- Department of Radiology, Medical Centre - University of Freiburg, Freiburg, BW, Germany
| | - Waseem Masalha
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
| | - Bianca Mercas
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
| | - Irina Mader
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
- Specialist Centre for Radiology, Schoen Clinic, Vogtareuth, BY, Germany
| | - Peter Reinacher
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
- Department of Neurosurgery, Division Stereotactic and Functional Neurosurgery, Medical Center- University of Freiburg, Freiburg, BW, Germany
| | | | - Christian Fung
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
| | - Dieter Henrik Heiland
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
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Opoku-Darko M, Amuah JE, Kelly JJP. Surgical Resection of Anterior and Posterior Butterfly Glioblastoma. World Neurosurg 2017; 110:e612-e620. [PMID: 29162526 DOI: 10.1016/j.wneu.2017.11.059] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/08/2017] [Accepted: 11/11/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence suggests a survival benefit for patients with glioblastoma who undergo maximal safe surgical resection. Not all glioblastomas are amenable to surgical resection and anatomic location is one potentially limiting factor. Glioblastomas that invade the corpus callosum and cross midline to the contralateral hemisphere-butterfly glioblastomas (bGBMs)-are one subgroup of tumors traditionally deemed inoperable. METHODS We evaluate the management of bGBMs at our institution to assess whether surgical resection is feasible, safe, and more effective than biopsy. We retrospectively reviewed our institutional brain tumor registry for all adult patients treated for glioblastoma (World Health Organization grade IV) between 2004 and 2016 to identify all bGBMs. RESULTS Survival between biopsy and resection was assessed using the Kaplan-Meier model. Twenty-nine (3.8%) of 764 newly diagnosed GBMs were identified as bGBM. Of these, 9 patients (31.0%) underwent surgical resection and 20 patients (69.0%) underwent biopsy. Five patients (55.6%) in the surgical resection group had 98% extent of resection or greater. Median survival of our entire cohort of patients was 3.3 months. Median survival was higher in the surgical resection groups (7.8 vs. 2.8 months; P = 0.0019). Increased age is independently associated with increased risk of death, and adjuvant therapy is independently associated with prolonged survival. CONCLUSIONS Surgical resection of butterfly glioblastoma prolongs survival without increased risk of permanent neurologic deficit. Both anterior and posterior bGBMs can be resected safely.
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Affiliation(s)
| | - Joseph E Amuah
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - John J P Kelly
- Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada; The Arne Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada.
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