Prognostic validation of a new classification system for extent of resection in glioblastoma: A report of the RANO resect group

Philipp Karschnia, Jacob S. Young, Antonio Dono, Levin Haeni, Tommaso Sciortino, Francesco Bruno, Stephanie T. Juenger, Nico Teske, Ramin A. Morshed, Alexander F. Haddad, Yalan Zhang, Sophia Stoecklein, Michael Weller, Michael A. Vogelbaum, Juergen Beck, Nitin Tandon, Shawn Hervey-Jumper, Annette M. Molinaro, Roberta Ruda, Lorenzo BelloOliver Schnell, Yoshua Esquenazi, Maximilian Ruge, Stefan J. Grau, Mitchel S. Berger, Susan M. Chang, Martin van den Bent, Joerg-Christian Tonn*

*Corresponding author for this work

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Abstract

Background Terminology to describe extent of resection in glioblastoma is inconsistent across clinical trials. A surgical classification system was previously proposed based upon residual contrast-enhancing (CE) tumor. We aimed to (1) explore the prognostic utility of the classification system and (2) define how much removed non-CE tumor translates into a survival benefit. Methods The international RANO resect group retrospectively searched previously compiled databases from 7 neuro-oncological centers in the USA and Europe for patients with newly diagnosed glioblastoma per WHO 2021 classification. Clinical and volumetric information from pre- and postoperative MRI were collected. Results We collected 1,008 patients with newly diagnosed IDHwt glioblastoma. 744 IDHwt glioblastomas were treated with radiochemotherapy per EORTC-26981/22981 (TMZ/RT -> TMZ) following surgery. Among these homogenously treated patients, lower absolute residual tumor volumes (in cm(3)) were favorably associated with outcome: patients with "maximal CE resection" (class 2) had superior outcome compared to patients with "submaximal CE resection" (class 3) or "biopsy" (class 4). Extensive resection of non-CE tumor (

Original languageEnglish
Number of pages15
JournalNeuro-Oncology
DOIs
Publication statusE-pub ahead of print - 12 Aug 2022

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