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Defining Glioblastoma Resectability Through the Wisdom of the Crowd: A Proof-of-Principle Study.

TitleDefining Glioblastoma Resectability Through the Wisdom of the Crowd: A Proof-of-Principle Study.
Publication TypeJournal Article
Year of Publication2017
AuthorsSonabend AM, Zacharia BE, Cloney MB, Sonabend A, Showers C, Ebiana V, Nazarian M, Swanson KR, Baldock A, Brem H, Bruce JN, Butler W, Cahill DP, Carter B, Orringer DA, Roberts DW, Sagher O, Sanai N, Schwartz TH, Silbergeld DL, Sisti MB, Thompson RC, Waziri AE, Ghogawala Z, McKhann G
JournalNeurosurgery
Volume80
Issue4
Pagination590-601
Date Published2017 04 01
ISSN1524-4040
KeywordsAdolescent, Adult, Aged, Brain Neoplasms, Female, Glioblastoma, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neoplasm, Residual, Neurosurgical Procedures, Pilot Projects
Abstract

BACKGROUND: Extent of resection (EOR) correlates with glioblastoma outcomes. Resectability and EOR depend on anatomical, clinical, and surgeon factors. Resectability likely influences outcome in and of itself, but an accurate measurement of resectability remains elusive. An understanding of resectability and the factors that influence it may provide a means to control a confounder in clinical trials and provide reference for decision making.

OBJECTIVE: To provide proof of concept of the use of the collective wisdom of experienced brain tumor surgeons in assessing glioblastoma resectability.

METHODS: We surveyed 13 academic tumor neurosurgeons nationwide to assess the resectability of newly diagnosed glioblastoma. Participants reviewed 20 cases, including digital imaging and communications in medicine-formatted pre- and postoperative magnetic resonance images and clinical vignettes. The selected cases involved a variety of anatomical locations and a range of EOR. Participants were asked about surgical goal, eg, gross total resection, subtotal resection (STR), or biopsy, and rationale for their decision. We calculated a "resectability index" for each lesion by pooling responses from all 13 surgeons.

RESULTS: Neurosurgeons' individual surgical goals varied significantly ( P = .015), but the resectability index calculated from the surgeons' pooled responses was strongly correlated with the percentage of contrast-enhancing residual tumor ( R = 0.817, P < .001). The collective STR goal predicted intraoperative decision of intentional STR documented on operative notes ( P < .01) and nonresectable residual ( P < .01), but not resectable residual.

CONCLUSION: In this pilot study, we demonstrate the feasibility of measuring the resectability of glioblastoma through crowdsourcing. This tool could be used to quantify resectability, a potential confounder in neuro-oncology clinical trials.

DOI10.1227/NEU.0000000000001374
Alternate JournalNeurosurgery
PubMed ID27509070
PubMed Central IDPMC5888974
Grant ListDP5 OD021356 / OD / NIH HHS / United States
U01 CA220378 / CA / NCI NIH HHS / United States