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Results of a multicenter survey showing interindividual variability among neurosurgeons when deciding on the radicality of surgical resection in glioblastoma highlight the need for more objective guidelines

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Abstract

Purpose

We assessed agreement among neurosurgeons on surgical approaches to individual glioblastoma patients and between their approach and those recommended by the topographical staging system described by Shinoda.

Methods

Five neurosurgeons were provided with pre-surgical MRIs of 76 patients. They selected the surgical approach [biopsy, partial resection, or gross total resection (GTR)] that they would recommend for each patient. They were blinded to each other’s response and they were told that patients were younger than 50 years old and without symptoms. Three neuroradiologists classified each case according to the Shinoda staging system.

Results

Biopsy was recommended in 35.5–82.9%, partial resection in 6.6–32.9%, and GTR in 3.9–31.6% of cases. Agreement among their responses was fair (global kappa = 0.28). Nineteen patients were classified as stage I, 14 as stage II, and 43 as stage III. Agreement between the neurosurgeons and the recommendations of the staging system was poor for stage I (kappa = 0.14) and stage II (kappa = 0.02) and fair for stage III patients (kappa = 0.29). An individual analysis revealed that in contrast to the Shinoda system, neurosurgeons took into account T2/FLAIR sequences and gave greater weight to the involvement of eloquent areas.

Conclusions

The surgical approach to glioblastoma is highly variable. A staging system could be used to examine the impact of extent of resection, monitor post-operative complications, and stratify patients in clinical trials. Our findings suggest that the Shinoda staging system could be improved by including T2/FLAIR sequences and a more adequate weighting of eloquent areas.

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Author information

Author notes

    Authors and Affiliations

    1. Neuro-radiology Service, Hospital del Mar, 08003, Barcelona, Spain

      J. Capellades, S. Medrano & S. Gonzalez

    2. Neurosurgery Service, Hospital Universitari Germans Trias i Pujol, IGTP, 08916, Badalona, Spain

      P. Teixidor, C. Hostalot & R. Armengol

    3. Neurosurgery Service, Hospital del Mar, 08003, Barcelona, Spain

      G. Villalba

    4. Neurosurgery Service, Hospital de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, 08907, Barcelona, Spain

      G. Plans

    5. Medical Oncology Service, Institut Catala d’Oncologia, Hospital Universitari Germans Trias i Pujol, IGTP, Ctra Canyet, s/n, 08916, Badalona, Spain

      A. Estival, J. J. García-Mosquera & C. Balana

    6. Medical Oncology Service, Hospital Universitario Virgen de las Nieves, 18014, Granada, Spain

      R. Luque

    7. Medical Oncology Service, Institut Catala d’Oncologia, Hospital Duran i Reynals, IDIBELL, L’Hospitalet de Llobregat, 08908, Barcelona, Spain

      M. Gil-Gil

    8. Radiation Oncology Service, Institut Català d’Oncologia, Hospital Universitari Germans Trias i Pujol, IGTP, 08916, Badalona, Spain

      S. Villa

    9. Medical Oncology Service, Hospital Universitario 12 de Octubre, 28041, Madrid, Spain

      J. Sepulveda

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    1. J. Capellades
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    Correspondence to C. Balana.

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    Funding

    This study was funded by the Spanish Instituto Carlos III (FISS-ICIII: project EC08/00071).

    Conflict of interest

    The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

    Additional information

    J. Capellades and C. Balana contributed equally to the study.

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    Capellades, J., Teixidor, P., Villalba, G. et al. Results of a multicenter survey showing interindividual variability among neurosurgeons when deciding on the radicality of surgical resection in glioblastoma highlight the need for more objective guidelines. Clin Transl Oncol 19, 727–734 (2017). https://doi.org/10.1007/s12094-016-1598-6

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