The Impact of Surgery on Butterfly Gliomas – A Real-life Study of Biopsy versus Surgical Resection

Abstract

Introduction Although the extent of resection affects the overall survival of patients with gliomas, cytoreduction in patients with butterfly gliomas (BGs) remains controversial. Contemporary studies suggest that wide removal is feasible, but there is a lack of controlled, randomized, multicenter studies on the subject. The aim of the present study was to evaluate the impact of maximal safe resection (MSR) as a primary treatment strategy in patients with BG.

Methods A total of 30 consecutive patients, primarily treated with neurosurgery, were categorized into group A, in whom MSR was ≥ 50%, and group B, in whom MSR was < 50% (biopsy). The groups were studied and compared in terms of clinical and epidemiological characteristics, functionality, survival time (ST), and progression-free survival (PFS).

Results The results were analyzed through descriptive and inferential statistics. The most frequent tumor was IDH1-wild type glioblastoma, Grade 4 according to the World Health Organization (WHO) classification. Most patients (80%) had Karnofsky Performance Status (KPS) < 70%; however, there was no significant worsening in functionality associated with the interventions. Wider resections, i.e., those performed in group A, were associated with better Kaplan-Meier curves and ST compared with group B (68.35 versus 17.32 weeks respectively; p = 0.014). The PFS was also longer in group A compared to group B (57.70 versus 4.77 weeks, respectively; p = 0.012). In the multivariate analysis, resections > 50% were associated with reduced risk of recurrence (hazard ratio [HR] = 0.20; 95% confidence interval [95%CI] = 0.06–0.67; p = 0.009). The complication rates and functional decline were similar between groups.

Conclusion Surgical resections > 50% in patients with BG improved ST and PFS without a significant increase in morbidity or dysfunction.

Resumo

Introdução Embora a extensão da ressecção afetar a sobrevida geral dos pacientes com gliomas, a citorredução em pacientes com gliomas em asa de borboleta (GABs) permanece controversa. Apesar de estudos contemporâneos sugerirem que a remoção ampla é viável neste contexto, ainda faltam estudos controlados, randomizados e multicêntricos sobre o assunto. O objetivo deste estudo foi avaliar o impacto da máxima ressecção segura (MRS) como uma estratégia de tratamento primário em pacientes com GAB.

Métodos Ao todo, 30 pacientes consecutivos, tratados primariamente com neurocirurgia, foram categorizados como o grupo A, no qual a MRS foi ≥ 50%, e no grupo B, no qual a MRS foi < 50% (biópsia). Os grupos foram estudados e comparados quanto às características clínicas, epidemiológicas, funcionalidade, tempo de sobrevida (TS) e sobrevida livre de progressão (SLP).

Resultados Os resultados foram analisados por meio de técnicas de estatística descritiva e inferencial. O tumor mais frequente foi glioblastoma de tipo selvagem do gene IDH1, de grau 4 na classificação da Organização Mundial da Saúde (OMS). A maioria dos pacientes (80%) tinha Karnofsky Performance Status (KPS) < 70%, mas não houve piora significativa da funcionalidade associada às intervenções. Ressecções mais amplas, ou seja, as realizadas no grupo A, foram associadas a curvas de Kaplan-Meier e TS melhores em comparação com o grupo B (68,35 semanas versus 17,32 semanas, respectivamente; p = 0,014). A SLP também foi mais longa neste grupo em comparação com o grupo B (57,70 semanas versus 4,77 semanas, respectivamente; p = 0,012). Na análise multivariada, ressecções > 50% foram associadas a um risco reduzido de recorrência (razão de risco [RR] = 0,20; intervalo de confiança de 95% [IC95%] = 0,06–0,67; p = 0,009). As taxas de complicações e o declínio funcional foram semelhantes entre os grupos.

Conclusão Em pacientes com GAB, as ressecções cirúrgicas (> 50%) melhoraram o TS e a SLP, sem aumento significativo na morbidade e nas disfunções.

Keywords

butterfly glioma - biopsy - surgical resection - survival - progression-free survival

Palavras-chave

gliomas em asa de borboleta - biopsia - ressecção cirúrgica - sobrevida - sobrevida livre de progressão

Publikationsverlauf

Eingereicht: 18. Juni 2024

Angenommen: 21. Oktober 2024

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Ostrom QT, Price M, Neff C. et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2015-2019. Neuro-oncol 2022; 24 (5, Suppl 5): v1-v95
• 2 Palmisciano P, Ferini G, Watanabe G. et al. Gliomas Infiltrating the Corpus Callosum: A Systematic Review of the Literature. Cancers (Basel) 2022; 14 (10) 2507
• 3 Dziurzynski K, Blas-Boria D, Suki D. et al. Butterfly glioblastomas: a retrospective review and qualitative assessment of outcomes. J Neurooncol 2012; 109 (03) 555-563
• 4 Bjorland LS, Dæhli Kurz K, Fluge Ø. et al. Butterfly glioblastoma: Clinical characteristics, treatment strategies and outcomes in a population-based cohort. Neurooncol Adv 2022; 4 (01) vdac102
• 5 Tunthanathip T, Ratanalert S, Sae-Heng S, Oearsakul T. Butterfly tumor of the corpus callosum: Clinical characteristics, diagnosis, and survival analysis. J Neurosci Rural Pract 2017; 8 (5, Suppl 1): S57-S65
• 6 Molinaro AM, Hervey-Jumper S, Morshed RA. et al. Association of Maximal Extent of Resection of Contrast-Enhanced and Non-Contrast-Enhanced Tumor With Survival Within Molecular Subgroups of Patients With Newly Diagnosed Glioblastoma. JAMA Oncol 2020; 6 (04) 495-503
• 7 Li YM, Suki D, Hess K, Sawaya R. The influence of maximum safe resection of glioblastoma on survival in 1229 patients: Can we do better than gross-total resection?. J Neurosurg 2016; 124 (04) 977-988
• 8 Wang L, Liang B, Li YI, Liu X, Huang J, Li YM. What is the advance of extent of resection in glioblastoma surgical treatment-a systematic review. Chin Neurosurg J 2019; 5 (01) 2
• 9 Franco P, Delev D, Cipriani D. et al. Surgery for IDH1/2 wild-type glioma invading the corpus callosum. Acta Neurochir (Wien) 2021; 163 (04) 937-945
• 10 Chaichana KL, Jusue-Torres I, Lemos AM. et al. The butterfly effect on glioblastoma: is volumetric extent of resection more effective than biopsy for these tumors?. J Neurooncol 2014; 120 (03) 625-634
• 11 Chojak R, Koźba-Gosztyła M, Słychan K. et al. Impact of surgical resection of butterfly glioblastoma on survival: a meta-analysis based on comparative studies. Sci Rep 2021; 11 (01) 13934
• 12 Siddiqui J, Krishnan AS. Butterfly Glioma. N Engl J Med 2018; 378 (03) 281-281
• 13 Beaumont TL, Mohammadi AM, Kim AH, Barnett GH, Leuthardt EC. Magnetic resonance imaging-guided laser interstitial thermal therapy for glioblastoma of the corpus callosum. Neurosurgery 2018; 83 (03) 556-565
• 14 Burks JD, Bonney PA, Conner AK. et al. A method for safely resecting anterior butterfly gliomas: the surgical anatomy of the default mode network and the relevance of its preservation. J Neurosurg 2017; 126 (06) 1795-1811
• 15 Opoku-Darko M, Amuah JE, Kelly JJP. Surgical Resection of Anterior and Posterior Butterfly Glioblastoma. World Neurosurg 2018; 110: e612-e620
• 16 Dayani F, Young JS, Bonte A. et al. Safety and outcomes of resection of butterfly glioblastoma. Neurosurg Focus 2018; 44 (06) E4
• 17 Chawla S, Kavouridis VK, Boaro A. et al. Surgery vs. Biopsy in the Treatment of Butterfly Glioblastoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14 (02) 314
• 18 Müller DMJ, De Swart ME, Ardon H. et al. Timing of glioblastoma surgery and patient outcomes: a multicenter cohort study. Neurooncol Adv 2021; 3 (01) vdab053