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Journal of Neuro-Oncology
Published in: Journal of Neuro-Oncology 2/2019

01-06-2019 | Glioma | Clinical Study

Evaluation of pediatric glioma outcomes using intraoperative MRI: a multicenter cohort study

Authors: Michael Karsy, S. Hassan Akbari, David Limbrick, Eric C. Leuthardt, John Evans, Matthew D. Smyth, Jennifer Strahle, Jeffrey Leonard, Samuel Cheshier, Douglas L. Brockmeyer, Robert J. Bollo, John R. Kestle, John Honeycutt, David J. Donahue, Richard A. Roberts, Daniel R. Hansen, Jay Riva-Cambrin, Garnette Sutherland, Clair Gallagher, Walter Hader, Yves Starreveld, Mark Hamilton, Ann-Christine Duhaime, Randy L. Jensen, Michael R. Chicoine

Published in: Journal of Neuro-Oncology | Issue 2/2019

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Abstract

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.
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Metadata
Title
Evaluation of pediatric glioma outcomes using intraoperative MRI: a multicenter cohort study
Authors
Michael Karsy
S. Hassan Akbari
David Limbrick
Eric C. Leuthardt
John Evans
Matthew D. Smyth
Jennifer Strahle
Jeffrey Leonard
Samuel Cheshier
Douglas L. Brockmeyer
Robert J. Bollo
John R. Kestle
John Honeycutt
David J. Donahue
Richard A. Roberts
Daniel R. Hansen
Jay Riva-Cambrin
Garnette Sutherland
Clair Gallagher
Walter Hader
Yves Starreveld
Mark Hamilton
Ann-Christine Duhaime
Randy L. Jensen
Michael R. Chicoine
Publication date
01-06-2019
Publisher
Springer US
Published in
Journal of Neuro-Oncology / Issue 2/2019
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI
https://doi.org/10.1007/s11060-019-03154-7

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