Don’t have surgery if you have glioma?

Don’t have surgery if you have glioma? Many patients have misunderstandings about craniotomy.

Gliomas represent tumors with extensive heterogeneity with different behaviors and prognosis, and they are derived from a complex molecular structure.

Modern glioma surgery improves the symptom management, quality of life, progression-free survival (PFS) and overall survival (OS) of low-grade and high-grade gliomas (LGG and HGG) from safe and extremely tumor resection. Come.

However, in the absence of primary data, the overwhelming support for this idea mainly came from retrospective series. Therefore, the effects of increasing the scope of resection (EOR) and reducing tumor burden on the efficacy of postoperative chemotherapy and radiotherapy and the survival rate have not been fully defined. This is especially true, because gliomas represent widely heterogeneous tumors with different behaviors and prognosis, and they are derived from a complex molecular structure.

The neurosurgery community has made great efforts to define the clinical benefits of maximal tumor resection, with special attention to the gradual understanding of the molecular heterogeneity of gliomas. In order to reduce the neurological risks associated with increasing the resection rate, some important new technologies have also been developed at the same time. These developments reflect the modern goal of glioma surgery, which is to find the best balance between tumor resection and nerve damage.

Don’t have surgery if you have glioma? But in fact, it’s not

The development of modern glioma surgery revolves around safe and large tumor resection to improve the symptoms, quality of life, progression-free survival (PFS) and overall survival (OS) of low-grade and high-grade gliomas (LGG and HGG) This principle. Among the prognostic factors of glioma patients, such as age, tumor histology, functional status, and certain molecular markers, the degree of resection is unique in that it represents a modifiable variable that directly affects the surgeon’s ability. The clinical outcome is through safe and aggressive tumor resection.

However, the infiltrative nature of gliomas tends to spread to the brain and white matter under the microscope, which is a unique challenge for complete resection. In particular, the volume measurement of tumor size, EOR, and postoperative residual tumor volume is usually performed in the tumor contrast-enhanced area, instead of measuring the T2/flair high-intensity area.

Considering that the tumor-infiltrated brain is not always enhanced, relying on contrast enhancement underestimates the full extent of tumor burden. This is particularly relevant in the case of diffuse infiltrating non-enhanced LGG, because the differentiation of tumor volume mainly depends on the differentiation of T2/FLAIR abnormalities.

Therefore, total resection (GTR), defined as a complete imaging resection of HGG acting as a region, and a region of T2/FALIR enhanced lesions, cannot always completely remove all microscopic remnants. In addition, it is necessary to be cautious to maximize the resection rate because it cannot Identifying and preserving effective brain regions and pursuing complete resection will significantly impair the patient’s performance and quality of life, and have serious prognostic effects.

“Surgery is not recommended” does not mean “cannot operate”

In the absence of primary data, the overwhelming support for maximizing the resection rate mainly comes from retrospective series. However, despite the specific benefits of safety, the efficacy of subsequent chemotherapy and radiotherapy is greatly removed, and ultimately provides support for a better prognosis. However, the effect of radiotherapy and chemotherapy after surgery is obviously better than that of direct radiotherapy and chemotherapy, which also provides evidence for the important role of surgical resection.

Some surgical aids have been developed to assist in real-time identification of tumors, their infiltration boundaries, and their relationship with key anatomical and effective structures. These intraoperative auxiliary equipment include: intraoperative magnetic resonance imaging (iMRI), intraoperative electrophysiological monitoring, fluorescence-guided resection, cortical stimulation mapping and ultrasound, which enhance the surgeon’s ability to increase the range of resection, while greatly reducing the The critical neurovascular structure and the risk of a flexible brain.

Although the status of the first-line treatment of surgery is unshakable, and assistive technologies are constantly emerging, there are still patients who say: My attending doctor does not recommend surgery.

Sometimes it may be because the lesion is malignant and the tumor cells spread rapidly. Many high-grade glioma patients may be told that surgery can only strive for short-term survival and improve the quality of life, so that the patient will not be too painful at the end of life, so the patient His family members should carefully consider the necessity of surgery.

However, patients should realize that “surgery is the first choice for glioma treatment”. Although there is no first-level evidence to clarify the prognostic benefit of increasing resection rate, the consistency of existing data supports the long-term adherence to the principle, Safe and maximum tumor resection improves the symptom management, quality of life, PFS and OS of glioma patients.

At the same time, we are still diligently seeking new targeted therapies and innovative drug delivery technologies, hoping to have the opportunity to overcome the problem of glioma. However, the current goal of neurosurgeons is still to find the best balance between removing the tumor to a large extent and preserving nerve function to a large extent.

(source:internet, reference only)

Disclaimer of medicaltrend.org