Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection: A report of the RANO resect group

Karschnia P, Dono A, Young JS, Juenger ST, Teske N, Häni L, Sciortino T, Mau CY, Bruno F, Nunez L, Morshed RA, Haddad AF, Weller M, van den Bent M, Beck J, Hervey-Jumper S, Molinaro AM, Tandon N, Rudà R, Vogelbaum MA, Bello L, Schnell O, Grau SJ, Chang SM, Berger MS, Esquenazi Y, Tonn JC (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Neuro-Oncology Oxford University Press

Book Volume: 25

Pages Range: 1672-1685

Journal Issue: 9

DOI: 10.1093/neuonc/noad074

Abstract

BACKGROUND: The value of re-resection in recurrent glioblastoma remains controversial as a randomized trial that specifies intentional incomplete resection cannot be justified ethically. Here, we aimed to (1) explore the prognostic role of extent of re-resection using the previously proposed Response Assessment in Neuro-Oncology (RANO) classification (based upon residual contrast-enhancing (CE) and non-CE tumor), and to (2) define factors consolidating the surgical effects on outcome. METHODS: The RANO resect group retrospectively compiled an 8-center cohort of patients with first recurrence from previously resected glioblastomas. The associations of re-resection and other clinical factors with outcome were analyzed. Propensity score-matched analyses were constructed to minimize confounding effects when comparing the different RANO classes. RESULTS: We studied 681 patients with first recurrence of Isocitrate Dehydrogenase (IDH) wild-type glioblastomas, including 310 patients who underwent re-resection. Re-resection was associated with prolonged survival even when stratifying for molecular and clinical confounders on multivariate analysis; ≤1 cm3 residual CE tumor was associated with longer survival than non-surgical management. Accordingly, "maximal resection" (class 2) had superior survival compared to "submaximal resection" (class 3). Administration of (radio-)chemotherapy in the absence of postoperative deficits augmented the survival associations of smaller residual CE tumors. Conversely, "supramaximal resection" of non-CE tumor (class 1) was not associated with prolonged survival but was frequently accompanied by postoperative deficits. The prognostic role of residual CE tumor was confirmed in propensity score analyses. CONCLUSIONS: The RANO resect classification serves to stratify patients with re-resection of glioblastoma. Complete resection according to RANO resect classes 1 and 2 is prognostic.

Authors with CRIS profile

Oliver Schnell

Involved external institutions

Ludwig-Maximilians-Universität (LMU) DE Germany (DE) University of Texas Health Science Center at Houston (UTHealth) US United States (USA) (US) University of San Francisco (USF) US United States (USA) (US) Universität zu Köln DE Germany (DE) Universitätsklinikum Freiburg DE Germany (DE) Università degli studi di Milano IT Italy (IT) H. Lee Moffitt Cancer Center & Research Institute US United States (USA) (US) University of Turin / Università degli Studi di Torino (UNITO) IT Italy (IT) Universitätsspital Zürich (USZ) CH Switzerland (CH) Erasmus University Medical Center (MC) NL Netherlands (NL)

How to cite

APA:

Karschnia, P., Dono, A., Young, J.S., Juenger, S.T., Teske, N., Häni, L.,... Tonn, J.C. (2023). Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection: A report of the RANO resect group. Neuro-Oncology, 25(9), 1672-1685. https://doi.org/10.1093/neuonc/noad074

MLA:

Karschnia, Philipp, et al. "Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection: A report of the RANO resect group." Neuro-Oncology 25.9 (2023): 1672-1685.

BibTeX: Download