SURG-04BETTER IN THE BUCKET: EXTENSIVE RESECTION IMPROVES SURVIVAL IN GLIOBLASTOMA- A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE WORLD'S LITERATURE
Authors: Timothy Brown, Matthew Brennan, Ephraim Church, Nicholas Brandmeir, Kevin Rakszawski, Dima Suki, Michael Li, Elias Rizk, Raymond Sawaya, Michael Glantz
Journal: Neuro-Oncology (2015)

SURG-04. BETTER IN THE BUCKET: EXTENSIVE RESECTION IMPROVES SURVIVAL IN GLIOBLASTOMAA SYSTEMATIC REVIEW AND META-ANALYSIS OF THE WORLD’S LITERATURE Timothy Brown1,2, Matthew Brennan3, Ephraim Church4, Nicholas Brandmeir4, Kevin Rakszawski5, Dima Suki6, Michael Li7, Elias Rizk4, Raymond Sawaya6, and Michael Glantz3,4; The Pennsylvania State University College of Medicine, Hershey, PA, USA; Department of Medicine, The University of Texas Southwestern Medical School, Dallas, TX, USA; Division of Hematology & Oncology, Department of Medicine, Penn State Hershey Cancer Institute, Hershey, PA, USA; Department of Neurosurgery, Penn State Milton S Hershey Medical Center, Hershey, PA, USA; Department of Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA, USA; Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA INTRODUCTION: Glioblastoma multiforme (GBM) remains an inescapably fatal disease notwithstanding optimal surgical and medical therapy. The relationship between  of tumor  (EOR) and outcome remains controversial despite many relevant studies. We present the results of a quantitative systematic review addressing the effect of EOR on survival in patients with GBM. METHODS: The terms glioblastoma, extent of resection, and resection were entered into search engines systematically with the guidance of an expert librarian. Articles were reviewed by all authors independently and then in consensus fashion. Data were analyzed to assess survival following gross total  (GTR), subtotal  (STR), and biopsy as defined by the individual studies. The overall body of evidence was evaluated according to GRADE criteria and PRISMA guidelines. RESULTS: Our search yielded 46 articles suitable for inclusion in the meta-analysis. There werenoclass I studies, 3 class II studies, and44class III or IVstudies.Ourmetaanalysis revealed improved oneand two-year survival for GTR compared to STR (RR 1⁄4 0.63, 95% CI 1⁄4 0.56-0.69; RR 1⁄4 0.85, 0.79-0.90) and STR compared to biopsy (RR 1⁄4 0.85, 0.80-0.91; RR 1⁄4 0.99, 0.97-1.00). Oneand two-year survival was also improved for any  compared to biopsy alone (RR 1⁄4 0.77, 0.71-0.84; RR 1⁄4 0.94, 0.89-1.00). These outcomes were unaltered by the inclusion of SEER and RTOG population studies, or when restricted to the class II studies. The quality of the total body of evidence by GRADE criteria was  CONCLUSIONS: Ours represents the largest systematic review and meta-analysis ever performed on this subject. Greater EOR unquestionably correlates with improved one and two-year survival, but the qualityof evidence is poor. Randomized trials have not proved feasible. Further cohort studies will not provide additional useful data, and should not be performed. A prospective registry of GBM patients represents a valuable alternative and is a critical priority for the neuro-oncology community. Neuro-Oncology 17:v214–v220, 2015. doi:10.1093/neuonc/nov235.4 Published by Oxford University Press on behalf of the Society for Neuro-Oncology 2015.