TY - JOUR
T1 - Evaluation of pediatric glioma outcomes using intraoperative MRI
T2 - a multicenter cohort study
AU - Karsy, Michael
AU - Akbari, S. Hassan
AU - Limbrick, David
AU - Leuthardt, Eric C.
AU - Evans, John
AU - Smyth, Matthew D.
AU - Strahle, Jennifer
AU - Leonard, Jeffrey
AU - Cheshier, Samuel
AU - Brockmeyer, Douglas L.
AU - Bollo, Robert J.
AU - Kestle, John R.
AU - Honeycutt, John
AU - Donahue, David J.
AU - Roberts, Richard A.
AU - Hansen, Daniel R.
AU - Riva-Cambrin, Jay
AU - Sutherland, Garnette
AU - Gallagher, Clair
AU - Hader, Walter
AU - Starreveld, Yves
AU - Hamilton, Mark
AU - Duhaime, Ann Christine
AU - Jensen, Randy L.
AU - Chicoine, Michael R.
N1 - Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Background: The use of intraoperative MRI (iMRI) during treatment of gliomas may increase extent of resection (EOR), decrease need for early reoperation, and increase progression-free and overall survival, but has not been fully validated, particularly in the pediatric population. Objective: To assess the accuracy of iMRI to identify residual tumor in pediatric patients with glioma and determine the effect of iMRI on decisions for resection, complication rates, and other outcomes. Methods: We retrospectively analyzed a multicenter database of pediatric patients (age ≤ 18 years) who underwent resection of pathologically confirmed gliomas. Results: We identified 314 patients (mean age 9.7 ± 4.6 years) with mean follow-up of 48.3 ± 33.6 months (range 0.03–182.07 months) who underwent surgery with iMRI. There were 201 (64.0%) WHO grade I tumors, 57 (18.2%) grade II, 24 (7.6%) grade III, 9 (2.9%) grade IV, and 23 (7.3%) not classified. Among 280 patients who underwent resection using iMRI, 131 (46.8%) had some residual tumor and underwent additional resection after the first iMRI. Of the 33 tissue specimens sent for pathological analysis after iMRI, 29 (87.9%) showed positive tumor pathology. Gross total resection was identified in 156 patients (55.7%), but this was limited by 69 (24.6%) patients with unknown EOR. Conclusions: Analysis of the largest multicenter database of pediatric gliomas resected using iMRI demonstrated additional tumor resection in a substantial portion of cases. However, determining the impact of iMRI on EOR and outcomes remains challenging because iMRI use varies among providers nationally. Continued refinement of iMRI techniques for use in pediatric patients with glioma may improve outcomes.
AB - Background: The use of intraoperative MRI (iMRI) during treatment of gliomas may increase extent of resection (EOR), decrease need for early reoperation, and increase progression-free and overall survival, but has not been fully validated, particularly in the pediatric population. Objective: To assess the accuracy of iMRI to identify residual tumor in pediatric patients with glioma and determine the effect of iMRI on decisions for resection, complication rates, and other outcomes. Methods: We retrospectively analyzed a multicenter database of pediatric patients (age ≤ 18 years) who underwent resection of pathologically confirmed gliomas. Results: We identified 314 patients (mean age 9.7 ± 4.6 years) with mean follow-up of 48.3 ± 33.6 months (range 0.03–182.07 months) who underwent surgery with iMRI. There were 201 (64.0%) WHO grade I tumors, 57 (18.2%) grade II, 24 (7.6%) grade III, 9 (2.9%) grade IV, and 23 (7.3%) not classified. Among 280 patients who underwent resection using iMRI, 131 (46.8%) had some residual tumor and underwent additional resection after the first iMRI. Of the 33 tissue specimens sent for pathological analysis after iMRI, 29 (87.9%) showed positive tumor pathology. Gross total resection was identified in 156 patients (55.7%), but this was limited by 69 (24.6%) patients with unknown EOR. Conclusions: Analysis of the largest multicenter database of pediatric gliomas resected using iMRI demonstrated additional tumor resection in a substantial portion of cases. However, determining the impact of iMRI on EOR and outcomes remains challenging because iMRI use varies among providers nationally. Continued refinement of iMRI techniques for use in pediatric patients with glioma may improve outcomes.
KW - Extent of resection
KW - Glioma
KW - Intraoperative MRI
KW - Outcome
KW - Pediatric
KW - WHO grade
KW - World Health of Organization
KW - iMRI
UR - http://www.scopus.com/inward/record.url?scp=85064348645&partnerID=8YFLogxK
U2 - 10.1007/s11060-019-03154-7
DO - 10.1007/s11060-019-03154-7
M3 - Article
C2 - 30977059
AN - SCOPUS:85064348645
SN - 0167-594X
VL - 143
SP - 271
EP - 280
JO - Journal of Neuro-Oncology
JF - Journal of Neuro-Oncology
IS - 2
ER -