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

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.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Sonabend 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 M

doi

10.1227/NEU.0000000000001374

subject

Has Abstract

pub_date

2017-04-01 00:00:00

pages

590-601

issue

eissn

0148-396X

issn

1524-4040

journal_volume

pub_type

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