Debulking surgery and Radiotherapy versus Biopsy and Radiotherapy in patients with High Grade Gliomas.

Abstract

From our study of management of high grade gliomas either with cytoreductive surgery or biopsy, we conclude the following: •HGGs include grade IV (GBM) and grade III gliomas which includes anaplastic astrocytomas, anaplastic ependymomas, anaplastic oligodendrogliomas, and mixed anaplastic gliomas. •High grade gliomas are common with age groups of fifth and sixth decades, and male patients than female, do not have any link with smoking, have weak link with familial syndromes such as neurofibromatosis type 1 and 2, Li-Fraumeni syndrome and Turcot`s syndrome. •HGGs have duration of symptoms less than 3 months mostly, present with headache, seizures either generalized or focal, disturbed conscious level due to increased intracranial pressure, and focal manifestation mainly as motor weakness. •Most patients with HGG seek medical consultation when they have mild or moderate neurological deficit. •On images, most HGG tumors locate in the temporal and parietal lobe, larger than 5 cm in size, and are associated with moderate or severe edema and mass effect. •Surgery for HGGs is either cytoreductive surgery or biopsy. Either gross or subtotal resection is used more than biopsy, as long as the goal of gross removal is feasible. Stereotactic biopsies should be indicated in patients with small or inaccessible tumors or those with poor medical condition. •Postoperative complications that more common with cytoreductive surgery than with stereotactic biopsy are neurological deficits, infection, and hematoma. •Postoperative residue differs according to extent of surgical resection; gross and subtotal resectionsare better than biopsy either excisional or stereotactic. •Radiotherapy is used after surgery as part of treatment for HGGs, either whole or 3 D conformational radiation, or both. • Prognostic score may be used to suspect outcome of patients withHGGs. •The most common cause of death of patients with HGGs is the tumor progression and increased intracranial pressure. Multiple prognostic factors for survival patients with HGG: - Age: Patients ≤ 40 years old have better survival more than those > 40 years old. - Tumor grade: HGGs grade III have better effect on survival more thangrade IV. - Duration of symptoms: Duration >3 months have better effect on survival more than duration ≤ 3 months. - Presence of seizures: It is non-significant prognostic factor for survival of patients with HGG. - Preoperative neurological state either assessed with NPS or KPS: It is a significant prognostic factor for survival of patients with HGGs. Preop. NPS grade 4 or KPS ≤ 70 have bad effect on survival. - Tumor size and localization: They are significant prognostic factors for patients with HGGs; those with size ≥ 5 cm and lesions outside frontal lobe; eitherdeep, lobar, or extensive have bad effect on survival. - Type of surgery: The cytoreductive surgery has better effect on survival of patients with HGGs more than biopsy. It is a significant prognostic factor for survival of patients with HGGs. - Postoperative residue: Gross or subtotal resection also have better effect on survival more than biopsy either excisional or stereotactic. - Pre-RT NPS: Those Pre-RT NPS grade 4 have bad effect on survival. - Radiotherapy: Radiotherapy and surgery have better effect on survival more than surgery alone. -Type of radiotherapy: Either whole or 3D conformational radiation is a significant prognostic factor for survival of patients with HGGs. - Prognostic score: It is a significant prognostic factor for survival of patients with HGGs, as it can suspectthe outcome of those affected patients.