11/20/2022 0 Comments Eloquent brain areasBetween January 2006 and December 2016, 533 patients were screened 392 patients were included in our study (see patient flowchart in Fig 1).įigure 1: Flowchart shows details of patient selection process. Inclusion criteria were as follows: (a) patients at least 18 years of age (b) newly diagnosed glioblastoma (c) supratentorial location (d) MRI performed in our institution (e) diagnosis of IDH wild-type glioblastoma on the basis of blinded neuropathologic reassessment performed previously by one evaluator (E.L.Z., with 15 years of experience) according to the 2016 World Health Organization classification (including the search for diffuse midline H3 K27M-mutant high-grade glioma by using immunohistochemistry, and the IDH1/2 sequencing following negative R132H IDH1 immunohistochemistry in glioblastomas from patients younger than 55 years) ( 1) and (f) postoperative modern standard-of-care treatment ( 13). We identified consecutive patients treated for a glioblastoma in a tertiary adult surgical neuro-oncology center. Such probabilistic MRI-based brain atlases have been developed for diffuse low-grade gliomas, including a proposal of a resection probability map ( 7, 8), and high-grade gliomas, including histomolecular findings ( 9– 12), but is lacking for IDH wild-type glioblastomas.įocusing on patients with supratentorial newly diagnosed IDH wild-type glioblastomas in adults in current practice and who received modern standard-of-care treatment ( 13), we aimed to assess the correlation between tumor location and (a) clinical presentation (age, symptoms, Karnofsky performance status), (b) surgical management (feasibility of a surgical resection, extent of resection), (c) imaging and histomolecular findings (involvement of the subventricular zone, O 6-methylguanine DNA methyltransferase promoter methylation status), and (d) outcomes (progression-free survival and overall survival ). Improvements in imaging after treatment improves the accuracy of neuro-anatomic studies owing to a voxel-based analysis and enables correlation studies. Tumor location is a key parameter in the care of patients with glioblastoma because it correlates with demographic characteristics, clinical presentation, histomolecular characteristics, surgical management, delivery of subsequent oncologic treatments, and, therefore, outcomes ( 2– 6). Isocitrate dehydrogenase (IDH) wild-type glioblastoma (World Health Organization grade IV astrocytoma) is the most common malignant primary brain tumor in adults ( 1). 05), and shortened overall survival (171 of 334 patients, P <. 05), treatment with biopsy only (183 of 392 patients, P <. 05), a neurologic deficit (282 of 392 patients, P <. In contrast, deep location and location within eloquent brain areas were more likely associated with an impaired functional status at diagnosis (44 of 392 patients, P <. 05), and prolonged overall survival (163 of 334 patients, P <. 05), a large surgical resection (173 of 392 patients, P <. The superficial location distant from the eloquent area was more likely associated with a preserved functional status at diagnosis (348 of 392 patients, P <. The authors identified the preferential location of glioblastomas according to subventricular zone, age, sex, clinical presentation, revised Radiation Therapy Oncology Group-Recursive Partitioning Analysis class, Karnofsky performance status, O 6-methylguanine DNA methyltransferase promoter methylation status, surgical management, and survival. A total of 392 patients (mean age, 61 years ± 13 233 men) were evaluated.
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