Effect of high-field iMRI guided resection in cerebral glioma surgery: A randomized clinical trial

Zeyang Li; Yanyan Song; N U Farrukh Hameed; Shiwen Yuan; Shuai Wu; Xiu Gong; Dongxiao Zhuang; Junfeng Lu; Fengping Zhu; Tianming Qiu; Jie Zhang; Abudumijiti Aibaidula; Xu Geng; Zhong Yang; Weijun Tang; Hong Chen; Liangfu Zhou; Ying Mao; Jinsong Wu

doi:10.1016/j.ejca.2024.113528

Effect of high-field iMRI guided resection in cerebral glioma surgery: A randomized clinical trial

Eur J Cancer. 2024 Mar:199:113528. doi: 10.1016/j.ejca.2024.113528. Epub 2024 Jan 9.

Authors

Zeyang Li¹, Yanyan Song², N U Farrukh Hameed³, Shiwen Yuan⁴, Shuai Wu¹, Xiu Gong⁵, Dongxiao Zhuang⁶, Junfeng Lu⁷, Fengping Zhu⁷, Tianming Qiu⁷, Jie Zhang⁷, Abudumijiti Aibaidula⁸, Xu Geng⁵, Zhong Yang⁹, Weijun Tang⁹, Hong Chen¹⁰, Liangfu Zhou⁷, Ying Mao¹¹, Jinsong Wu¹²

Affiliations

¹ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Wulumuqi Zhong Road 12, Shanghai 200040, China; Neurosurgical Institute of Fudan University, China.
² Department of Biostatistics, Clinical research institute, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
³ University of Pittsburgh Medical Center and Hillman Cancer Center, Department of Neurosurgery, Pittsburgh, USA.
⁴ Department of Psychiatry and Human Behavior, Brown University, Rhode Island Hospital, 146 West River Street, Providence, RI 02904, USA.
⁵ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Wulumuqi Zhong Road 12, Shanghai 200040, China.
⁶ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Wulumuqi Zhong Road 12, Shanghai 200040, China; National Neurological Diseases Center, China.
⁷ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Wulumuqi Zhong Road 12, Shanghai 200040, China; Neurosurgical Institute of Fudan University, China; National Neurological Diseases Center, China.
⁸ Department of Neurosurgery, University of Missouri in Columbia, One Hospital Drive, MO, 65212, Columbia.
⁹ Department of Radiotherapy, Huashan Hospital, Shanghai Medical College, Fudan University, Wulumuqi Zhong Road 12, Shanghai 200040, China.
¹⁰ Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, Wulumuqi Zhong Road 12, Shanghai 200040, China.
¹¹ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Wulumuqi Zhong Road 12, Shanghai 200040, China; Neurosurgical Institute of Fudan University, China; National Neurological Diseases Center, China; Institute of Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China.
¹² Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Wulumuqi Zhong Road 12, Shanghai 200040, China; Neurosurgical Institute of Fudan University, China; National Neurological Diseases Center, China; Institute of Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China. Electronic address: [email protected].

PMID: 38218157
DOI: 10.1016/j.ejca.2024.113528

Abstract

Background: Extent of resection (EOR) in glioma contributes to longer survival. The purpose of NCT01479686 was to prove whether intraoperative magnetic resonance imaging (iMRI) increases EOR in glioma surgery and benefit survival.

Methods: Patients were randomized (1:1) to receive the iMRI (n = 161) or the conventional neuronavigation (n = 160). The primary endpoint was gross total resection (GTR); secondary outcomes reported were progression-free survival (PFS), overall survival (OS), and safety.

Results: 188 high-grade gliomas (HGGs) and 133 low-grade gliomas (LGGs) were enrolled. GTR was 83.85% in the iMRI group vs. 50.00% in the control group (P < 0.0001). In 321 patients, the median PFS (mPFS) was 65.12 months in the iMRI group and 61.01 months in the control group (P = 0.0202). For HGGs, mPFS was improved in the iMRI group (19.32 vs. 13.34 months, P = 0.0015), and a trend of superior OS compared with control was observed (29.73 vs. 25.33 months, P = 0.1233). In the predefined eloquent area HGG subgroup, mPFS, and mOS were 20.47 months and 33.58 months in the iMRI vs. 12.21 months and 21.16 months in the control group (P = 0.0098; P = 0.0375, respectively). From the exploratory analyses of HGGs, residual tumor volume (TV) < 1.0 cm³ decreased the risk of survival (mPFS: 18.99 vs. 9.43 months, P = 0.0055; mOS: 29.77 vs. 18.10 months, P = 0.0042). LGGs with preoperative (pre-OP) TV > 43.1 cm³ and postoperative (post-OP) TV > 4.6 cm³ showed worse OS (P= 0.0117) CONCLUSIONS: It showed that iMRI significantly increased EOR and indicated survival benefits for HGGs, particularly eloquent HGGs. Residual TV in either HGGs or LGGs is a prognostic factor for survival.

Keywords: Cerebral glioma; High-grade glioma; Intraoperative magnetic resonance imaging (iMRI); Low-grade glioma; Surgery.

Publication types

Randomized Controlled Trial

MeSH terms

Brain Neoplasms* / diagnostic imaging
Brain Neoplasms* / surgery
Glioma* / diagnostic imaging
Glioma* / surgery
Humans
Magnetic Resonance Imaging / methods
Monitoring, Intraoperative / methods
Neurosurgical Procedures / adverse effects
Neurosurgical Procedures / methods
Retrospective Studies