Prognostic validation of a new classification system for extent of resection in glioblastoma: A report of the RANO resect group

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

Publication Type: Journal article

Publication year: 2023

Journal

Neuro-Oncology Oxford University Press

Book Volume: 25

Pages Range: 940-954

Journal Issue: 5

DOI: 10.1093/neuonc/noac193

Abstract

Background: Terminology to describe extent of resection in glioblastoma is inconsistent across clinical trials. A surgical classification system was previously proposed based upon residual contrast-enhancing (CE) tumor. We aimed to (1) explore the prognostic utility of the classification system and (2) define how much removed non-CE tumor translates into a survival benefit. Methods: The international RANO resect group retrospectively searched previously compiled databases from 7 neuro-oncological centers in the USA and Europe for patients with newly diagnosed glioblastoma per WHO 2021 classification. Clinical and volumetric information from pre-and postoperative MRI were collected. Results: We collected 1,008 patients with newly diagnosed IDHwt glioblastoma. 744 IDHwt glioblastomas were treated with radiochemotherapy per EORTC-26981/22981 (TMZ/RT→TMZ) following surgery. Among these homogenously treated patients, lower absolute residual tumor volumes (in cm3) were favorably associated with outcome: patients with "maximal CE resection"(class 2) had superior outcome compared to patients with "submaximal CE resection"(class 3) or "biopsy"(class 4). Extensive resection of non-CE tumor (≤5 cm3 residual non-CE tumor) was associated with better survival among patients with complete CE resection, thus defining class 1 ("supramaximal CE resection"). The prognostic value of the resection classes was retained on multivariate analysis when adjusting for molecular and clinical markers. Conclusions: The proposed "RANO categories for extent of resection in glioblastoma"are highly prognostic and may serve for stratification within clinical trials. Removal of non-CE tumor beyond the CE tumor borders may translate into additional survival benefit, providing a rationale to explicitly denominate such "supramaximal CE resection."

Authors with CRIS profile

Oliver Schnell

Involved external institutions

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

How to cite

APA:

Karschnia, P., Young, J.S., Dono, A., Häni, L., Sciortino, T., Bruno, F.,... Tonn, J.C. (2023). Prognostic validation of a new classification system for extent of resection in glioblastoma: A report of the RANO resect group. Neuro-Oncology, 25(5), 940-954. https://doi.org/10.1093/neuonc/noac193

MLA:

Karschnia, Philipp, et al. "Prognostic validation of a new classification system for extent of resection in glioblastoma: A report of the RANO resect group." Neuro-Oncology 25.5 (2023): 940-954.

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