The Safety and Usefulness of Awake Surgery as a Treatment Modality for Glioblastoma: A Retrospective Cohort Study and Literature Review
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Ethical Considerations
2.2. Study Design
2.3. Anesthesia
2.4. Tasks
2.5. Variables, Outcomes, and Definitions
2.6. Statistical Analysis
3. Results
3.1. The Demographic and Clinical Characteristics of the Participants
3.2. Anesthetic and Intraoperative Results
3.3. Adjuvant Therapy
3.4. Surgical Outcomes
3.5. Mapping Failure
3.6. PFS and OS
4. Discussion
Author, Year | Sample Size | EOR | Neurological Deficits | OS/PFS |
---|---|---|---|---|
Gerritsen, 2019 [3] | AC 37 vs. GA 111 | mean EOR: AC 94.89% vs. GA 70.30% (p = 0.0001) | Minor deficits 3 months after surgery: AC 3% vs. GA 15% (p = 0.05) Major deficits 3 months after surgery: AC 5% vs. GA 12% (p = 0.27) | median OS: AC 17 months vs. GA 15 months (p = 0.27) |
Gerritsen, 2022 [5] | AC 134 vs. GA 402 | mean EOR AC 95·4% vs. GA 86·3% (p < 0·0001) | 3 months after surgery: AC 22% vs. GA 33% (p = 0.019) | median PFS: AC 9.0 months vs. GA 7.3 months (p = 0.0060) median OS: AC 17.0 months vs. GA 14.0 months (p = 0.00054) |
Fukui, 2022 [7] | AC 15 vs. GA 15 | mean EOR AC 99.5% vs. GA 97.9% (p = 0.231) | NR | median OS: AC 30.4 months vs. GA 16.0 months (p = 0.381) |
Li, 2021 [6] | AC 48 vs. GA 61 | EOR ≧ 95%: AC 83.3% vs. GA 45.9% (p < 0.0001) mean EOR: AC 94.9% vs. GA 90.2% (p = 0.003) | NR | mean PFS: AC 23.2 months vs. GA 18.9 months (p = 0.001) mean OS: AC 28.1 months vs. GA 23.4 months (p < 0.001) |
Nakajima, 2021 [9] | AC 30 vs. GA 30 | mean EOR: AC 97.0% vs. GA 96.0% (ns) | NR | NR |
Gallet, 2022 [8] | AC res 36 vs. GA res 37 vs. GA bx 14 | EOR ≧ 90%: AC 50% vs. GA 51% (p = 1.000) | 1 month after surgery Language: AC res 19% vs. GA res 11% vs. GA bx 21% (p = 0.099) Motor: AC res 8% vs. GA res 5% vs. GA bx 36% (p < 0.001) | median PFS: AC res 7.3 months vs. GA res 11.6 months vs. GA bx 7.8 months (p = 0.285) median OS: AC res 17.5 months vs. GA res 23.4 months vs. GA bx 21.8 months (p = 0.650) |
Kim, 2009 [24] | AC 137 | EOR ≧ 95%: 73% | 1 month after surgery: 20% | NR |
Clavreul, 2021 [23] | AC 46 | EOR 100%: 61% EOR 90–99%: 33% | 3 months after surgery: 32.6% | median PFS 6.8 months median OS 17.6 months |
Present study | AC 32 | EOR 100%: 59% EOR 95–99%: 25% | Within 3 months after surgery: 25% Lasted over 3 months after surgery: 9% | median PFS 15.7 months median OS 36.9 months |
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | (% or IQR) | |
---|---|---|
Age, years, median (IQR) | 57 | (45–68) |
Men, (%) | 17 | (53) |
KPS on admission | 80 | (80–90) |
Pathological diagnosis | ||
Glioblastoma, IDH-wild | 27 | (84) |
Glioblastoma, IDH-mutant/Astrocytoma grade 4 | 4 | (13) |
Glioblastoma, NOS | 1 | (3) |
Location | ||
Frontal | 14 | (44) |
Temporal | 12 | (38) |
Parietal | 2 | (6) |
Multilobular | 4 | (13) |
Laterality | ||
Left | 29 | (91) |
Right | 1 | (3) |
Bilateral (butterfly glioma) | 2 | (6) |
Treatments | (%) | |
---|---|---|
Radiotherapy concomitant with TMZ | 32 | (100) |
Adjuvant TMZ | 32 | (100) |
Bevacizumab | 21 | (66) |
Other drugs | 10 | (31) |
Tumor-treating fields | 7 | (22) |
Reirradiation | 10 | (31) |
Repeat surgery | 10 | (31) |
Surgical Outcomes | ||
---|---|---|
Awake mapping, (%) | ||
Successfully completed | 28 | (88) |
Failure | 4 | (13) |
Positive response to awake mapping, (%) | ||
Cortical mapping | 10 | (31) |
Subcortical mapping | 11 | (34) |
Response to mapping results, (%) | ||
Stop resection | 13 | (41) |
EOR, (%) | ||
GTR | 19 | (59) |
STR | 8 | (25) |
PR | 3 | (9) |
Bx | 2 | (6) |
Seizure, (%) | ||
Intraoperative | 2 | (6) |
Postoperative, acute periods | 3 | (9) |
Early neurological deficits, (%) | 8 | (25) |
Late neurological deficits, (%) | 3 | (9) |
KPS 3 months after surgery, (IQR) | 90 | (80–90) |
OS, months, (95%CI) | 36.9 | (28.4–49.6) |
PFS, months, (95%CI) | 15.7 | (9.9–21.2) |
Failure (n = 4) | Successfully Completed (n = 28) | p Value | |||
---|---|---|---|---|---|
Age, years | 54 | (44–61) | 57 | (45–70) | 0.711 |
Male | 2 | (50) | 15 | (54) | 1 |
KPS ≦ 80 | 4 | (100) | 14 | (50) | 0.113 |
Maximal diameter, mm | 50 | (43–60) | 49 | (40–60) | 0.732 |
Time from anesthetic induction to extubation, minutes | 274 | (246–296) | 183 | (163–208) | 0.002 |
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Share and Cite
Osawa, S.; Miyakita, Y.; Takahashi, M.; Ohno, M.; Yanagisawa, S.; Kawauchi, D.; Omura, T.; Fujita, S.; Tsuchiya, T.; Matsumi, J.; et al. The Safety and Usefulness of Awake Surgery as a Treatment Modality for Glioblastoma: A Retrospective Cohort Study and Literature Review. Cancers 2024, 16, 2632. https://doi.org/10.3390/cancers16152632
Osawa S, Miyakita Y, Takahashi M, Ohno M, Yanagisawa S, Kawauchi D, Omura T, Fujita S, Tsuchiya T, Matsumi J, et al. The Safety and Usefulness of Awake Surgery as a Treatment Modality for Glioblastoma: A Retrospective Cohort Study and Literature Review. Cancers. 2024; 16(15):2632. https://doi.org/10.3390/cancers16152632
Chicago/Turabian StyleOsawa, Sho, Yasuji Miyakita, Masamichi Takahashi, Makoto Ohno, Shunsuke Yanagisawa, Daisuke Kawauchi, Takaki Omura, Shohei Fujita, Takahiro Tsuchiya, Junya Matsumi, and et al. 2024. "The Safety and Usefulness of Awake Surgery as a Treatment Modality for Glioblastoma: A Retrospective Cohort Study and Literature Review" Cancers 16, no. 15: 2632. https://doi.org/10.3390/cancers16152632
APA StyleOsawa, S., Miyakita, Y., Takahashi, M., Ohno, M., Yanagisawa, S., Kawauchi, D., Omura, T., Fujita, S., Tsuchiya, T., Matsumi, J., Sato, T., & Narita, Y. (2024). The Safety and Usefulness of Awake Surgery as a Treatment Modality for Glioblastoma: A Retrospective Cohort Study and Literature Review. Cancers, 16(15), 2632. https://doi.org/10.3390/cancers16152632