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Article

Feasibility, Safety and Impact on Overall Survival of Awake Resection for Newly Diagnosed Supratentorial IDH-Wildtype Glioblastomas in Adults

1
Department of Neurosurgery, GHU Site Sainte-Anne, F-75014 Paris, France
2
Université de Paris, 102-108 rue de la Santé, F-75014 Paris, France
3
Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
4
Swiss Foundation for Innovation and Training in Surgery (SFITS), 1205 Geneva, Switzerland
5
Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, 75014 Paris, France
6
Department of Neurosurgery, University of California, Los Angeles, CA 90095, USA
7
Department of Neurosurgery, CHU de Saint Etienne, 42270 Saint Etienne, France
8
Department of Neurosurgery, CHU Notre Dame de Secours, Byblos, Lebanon
9
Department of Neuroradiology, GHU Site Sainte-Anne, F-75014 Paris, France
10
Department of Neuropathology, GHU Site Sainte-Anne, F-75014 Paris, France
*
Author to whom correspondence should be addressed.
Academic Editor: Hiroaki Wakimoto
Cancers 2021, 13(12), 2911; https://doi.org/10.3390/cancers13122911
Received: 19 April 2021 / Revised: 1 June 2021 / Accepted: 5 June 2021 / Published: 10 June 2021
(This article belongs to the Special Issue Perioperative Imaging and Mapping Methods in Glioma Patients)
A few studies have suggested the benefits of awake surgery by maximizing the extent of resection while preserving neurological function and improving survival in high-grade glioma patients. However, the histomolecular heterogeneity in these series, mixing grade 3 with grade 4, and IDH-mutated with IDH-wildtype gliomas, represents a major selection bias that may influence survival analyses. For the first time, in a large homogeneous single-institution cohort of newly diagnosed supratentorial IDH-wildtype glioblastoma in adult patients, we assessed feasibility, safety and efficacy of awake surgery using univariate, multivariate and case-matched analysis. Awake surgery was associated with higher resection rates, lower residual tumor rates, and more supratotal resections than asleep resections, allowed standard radiochemotherapy to be performed systematically within a short time between surgery and radiotherapy, and was an independent predictor of progression-free survival and overall survival in the whole series, together with the extent of resection, MGMT promoter methylation status, and standard.
Background: Although awake resection using intraoperative cortico-subcortical functional brain mapping is the benchmark technique for diffuse gliomas within eloquent brain areas, it is still rarely proposed for IDH-wildtype glioblastomas. We have assessed the feasibility, safety, and efficacy of awake resection for IDH-wildtype glioblastomas. Methods: Observational single-institution cohort (2012–2018) of 453 adult patients harboring supratentorial IDH-wildtype glioblastomas who benefited from awake resection, from asleep resection, or from a biopsy. Case matching (1:1) criteria between the awake group and asleep group: gender, age, RTOG-RPA class, tumor side, location and volume and neurosurgeon experience. Results: In patients in the awake resection subgroup (n = 42), supratotal resections were more frequent (21.4% vs. 3.1%, p < 0.0001) while partial resections were less frequent (21.4% vs. 40.1%, p < 0.0001) compared to the asleep (n = 222) resection subgroup. In multivariable analyses, postoperative standard radiochemistry (aHR = 0.04, p < 0.0001), supratotal resection (aHR = 0.27, p = 0.0021), total resection (aHR = 0.43, p < 0.0001), KPS score > 70 (HR = 0.66, p = 0.0013), MGMT promoter methylation (HR = 0.55, p = 0.0031), and awake surgery (HR = 0.54, p = 0.0156) were independent predictors of overall survival. After case matching, a longer overall survival was found for awake resection (HR = 0.47, p = 0.0103). Conclusions: Awake resection is safe, allows larger resections than asleep surgery, and positively impacts overall survival of IDH-wildtype glioblastoma in selected adult patients. View Full-Text
Keywords: awake surgery; glioblastoma; IDH-wildtype; extent of resection; survival awake surgery; glioblastoma; IDH-wildtype; extent of resection; survival
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MDPI and ACS Style

Moiraghi, A.; Roux, A.; Peeters, S.; Pelletier, J.-B.; Baroud, M.; Trancart, B.; Oppenheim, C.; Lechapt, E.; Benevello, C.; Parraga, E.; Varlet, P.; Chrétien, F.; Dezamis, E.; Zanello, M.; Pallud, J. Feasibility, Safety and Impact on Overall Survival of Awake Resection for Newly Diagnosed Supratentorial IDH-Wildtype Glioblastomas in Adults. Cancers 2021, 13, 2911. https://doi.org/10.3390/cancers13122911

AMA Style

Moiraghi A, Roux A, Peeters S, Pelletier J-B, Baroud M, Trancart B, Oppenheim C, Lechapt E, Benevello C, Parraga E, Varlet P, Chrétien F, Dezamis E, Zanello M, Pallud J. Feasibility, Safety and Impact on Overall Survival of Awake Resection for Newly Diagnosed Supratentorial IDH-Wildtype Glioblastomas in Adults. Cancers. 2021; 13(12):2911. https://doi.org/10.3390/cancers13122911

Chicago/Turabian Style

Moiraghi, Alessandro, Alexandre Roux, Sophie Peeters, Jean-Baptiste Pelletier, Marwan Baroud, Bénédicte Trancart, Catherine Oppenheim, Emmanuèle Lechapt, Chiara Benevello, Eduardo Parraga, Pascale Varlet, Fabrice Chrétien, Edouard Dezamis, Marc Zanello, and Johan Pallud. 2021. "Feasibility, Safety and Impact on Overall Survival of Awake Resection for Newly Diagnosed Supratentorial IDH-Wildtype Glioblastomas in Adults" Cancers 13, no. 12: 2911. https://doi.org/10.3390/cancers13122911

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