Standardisation of the radiological definition of supramaximal resection in glioblastoma
- Author(s)
- Goran, A; Lasocki, A; Dimou, J;
- Journal Title
- Journal of Clinical Neuroscience
- Publication Type
- Online publication before print
- Abstract
- Glioblastoma remains the most common and lethal primary malignant brain tumour, with high rates of recurrence and progression despite gross-total resection of the contrast-enhancing region based on T1-weighted MRI. There has been growing interest in exploring "supramaximal" resections that extend beyond contrast-enhancing borders, with initial retrospective data suggesting survival benefit, but there is currently no consensus definition. In this systematic review, we explore the evolution of supramaximal resection in glioblastoma, dissect the incongruencies in the literature regarding its definition, qualitatively appraise each definition and discuss the results of various studies that have explored its impacts on patient outcomes. MEDLINE, EMBASE, SCOPUS, Cochrane Registry of Clinical Trials and Pub-MED were systematically searched for studies of glioblastoma patients who had undergone supramaximal resection. After screening and applying eligibility criteria, 25 studies were included in the final review. Definitions were grouped according to radiological modality and visualisation adjuncts and included various extents of resection of hyperintensity visualised using T2-Fluid-Attenuated Inversion Recovery, various volumetric resections of the non-contrast enhancing region, removal of methionine-uptake areas on PET, complete removal of 5-aminolevulinic acid fluorescent tissue and lobectomies. Our systematic review identified a general trend suggesting a survival benefit from supramaximal resection compared to gross-total resection but, more importantly, demonstrated the limitations of these studies due to selection bias and substantial methodological heterogeneity. Ultimately, our findings demonstrate the need for an applicable, standardised and specific definition for supramaximal resection so that prospective studies can determine prognostically significant clinical data to guide the surgical management of glioblastoma.
- Department(s)
- Cancer Imaging
- Publisher's Version
- https://doi.org/10.1016/j.jocn.2025.111037
- Open Access at Publisher's Site
https://doi.org/10.1016/j.jocn.2025.111037- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2025-01-21 12:22:27
Last Modified: 2025-01-21 12:27:30