Residual Enhancing Disease after Surgery for Glioblastoma: Evaluation of Practice in the United Kingdom

Ruichong Ma, Aswin Chari, Paul Brennan, Andrew Alalade, Ian E Anderson, Anna Solth, Hani J Marcus, Colin Watts

Research output: Contribution to journalArticlepeer-review


Background: A growing body of clinical data highlights the prognostic importance of achieving gross total resection (GTR) in patients with glioblastoma. The aim of this study was to determine nationwide practice and attitudes towards achieving GTR and dealing with residual enhancing disease (RED).
Methods: The study was in two parts: an electronic questionnaire sent to UK neuro-oncology surgeons to assess surgical practice followed by a 3-month prospective multi-centre observational study of current neurosurgical oncology practice.
Results: Twenty-seven surgeons representing 22 neurosurgical units completed the questionnaire. Prospective data was collected for 113 patients from 15 neurosurgical units. GTR was deemed to be achieved at time of surgery in 82% (91/111) of cases, but in only 45% (36/80) on postoperative MRI. RED was deemed operable in 16.3% (13/80) of cases, however, no patient underwent early repeat surgery for RED. The most commonly cited reason (38.5%, 5/13) was perceived lack of clinical benefit.
Conclusion: There is a subset of patients in which GTR is thought possible but not achieved at surgery, which, if resected early may improve overall survival. Further prospective surgical research is required to better define the prognostic implications of RED/GTR and examine the potential benefit of this early re-intervention.
Original languageEnglish
JournalNeuro-Oncology Practice
Early online date27 Sep 2017
Publication statusE-pub ahead of print - 27 Sep 2017


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