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Titolo:
Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome
Autore:
Keles, GE; Lamborn, KR; Berger, MS;
Indirizzi:
Univ Calif San Francisco, Dept Neurol Surg, Brain Tumor Res Ctr, San Francisco, CA 94143 USA Univ Calif San Francisco San Francisco CA USA 94143 ancisco, CA 94143 USA
Titolo Testata:
JOURNAL OF NEUROSURGERY
fascicolo: 5, volume: 95, anno: 2001,
pagine: 735 - 745
SICI:
0022-3085(200111)95:5<735:LHGIAA>2.0.ZU;2-T
Fonte:
ISI
Lingua:
ENG
Soggetto:
PROGNOSTIC FACTORS; RADIATION-THERAPY; CEREBRAL HEMISPHERES; SUPRATENTORIAL ASTROCYTOMAS; COMPUTED-TOMOGRAPHY; STATISTICAL-ANALYSIS; STEREOTAXIC BIOPSY; RANDOMIZED TRIAL; RADIOTHERAPY; SURVIVAL;
Keywords:
astrocytoma; glioma; oligodendroglioma; resection; outcome;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
69
Recensione:
Indirizzi per estratti:
Indirizzo: Berger, MS Univ Calif San Francisco, Dept Neurol Surg, Brain Tumor Res Ctr, 505 Parnassus Ave,Rm M-786, San Francisco, CA 94143 USA Univ Calif San Francisco 505 Parnassus Ave,Rm M-786 San Francisco CA USA 94143
Citazione:
G.E. Keles et al., "Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome", J NEUROSURG, 95(5), 2001, pp. 735-745

Abstract

Object. The goal of this study was to perform a critical review of literature pertinent to low-grade gliomas of the cerebral hemisphere in adults and, on the basis of this review, to evaluate systematically the prognostic effect of extent of resection on survival and to determine if treatment-related guidelines could be established for patients in whom these tumors have been newly diagnosed. Quality of evidence for current treatment options, guidelines, and standards as well as methodological limitations were evaluated. Methods. Several prognostic factors thought to affect outcome in patients with low-grade gliomas include the patient's age and neurological status, tumor volume and histological characteristics, and treatment-related variables such as timing of surgical intervention, extent of resection, postoperative tumor volume, and radiation therapy. Patient age and the histological characteristics of the lesion are generally accepted prognostic factors. Among treatment-related factors, timing and extent of resection are controversial because of the lack of randomized controlled trials addressing these issues and the difficulty in obtaining information from available studies that have methodological limitations. All English-language studies on low-grade gliomas published between January 1970 and April 2000 were reviewed. Thirty studies that included statistical analyses were further evaluated with regard to the prognostic effect of extent of resection. Of these 30 studies, those that included pediatric patients, unless adults were analyzed separately, were excluded from further study because of the favorable outcome associated with the pediatric age group. Also excluded were studies including pilocytic and gemistocytic astrocytomas, because the natural histories of these histological subtypes are significantly different from that of low-grade gliomas. Series in which there were small numbers of patients (< 75) were also excluded. Results for oligodendrogliomas are reported separately. Currently, for patients with low-grade glial tumors located in the cerebral hemisphere, the only management standard based on high-quality evidence is tissue diagnosis. All other treatment methods are practice options supported by evidence that is inconclusive or conflicting. The majority of published series that the authors identified had design-related limitations including a small study size, a small number of events (that is, deaths for survival studies), inclusion of pediatric patients, and/or inclusion of varioushistological types of tumors with different natural histories. Of the 30 series addressing the issue of timing and extent of surgery, almost all had additional design limitations. Methods used to determine the extent of resection were subjective and qualitative in almost all studies. Only five of the 30 series met the authors' criteria, and these studies are discussed in detail. Conclusions. Management of low-grade gliomas is controversial and practiceparameters are ill defined. This is caused by limited knowledge regarding the natural history of these tumors and the lack of high-quality evidence supporting various treatment options. Although a prospective randomized study seems unlikely, both retrospective matched studies and prospective observational trials will improve the clinician's ability to understand the importance of various prognostic factors.

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Documento generato il 27/01/20 alle ore 07:44:14