Biopsy versus resection for high grade glioma

Malignant gliomas are aggressive tumours of the nervous system. Resection (surgery to remove the tumour) may relieve symptoms but there is uncertainty that it extends survival. Biopsy can confirm diagnosis and carries fewer risks, but will not extend survival or improve symptoms. It is controversial as to which procedure is the best management option. One small trial looking at this problem was found but the trial proved inadequate and of low quality to answer the question conclusively. Larger well designed trails are required in the future.

Authors' conclusions: 

There is no high quality evidence on biopsy versus resection for HGG that can be used to guide management. The single included RCT is of inadequate methodology to reach reliable conclusions. Further large multi-centred RCTs are required to conclusively answer the question of whether biopsy or resection is the best initial surgical management for HGG.

Read the full abstract...
Background: 

Patients with a presumed high grade glioma (HGG) identified by clinical evaluation and radiological investigation have two initial surgical options; biopsy or resection. In certain situations, such as severe raised intra-cranial pressure, surgical resection is clinically indicated. Where surgical resection is not feasible, biopsy is the only reasonable option. Most patients fall somewhere between these extremes and in such circumstances it is uncertain which procedure offers the best surgical option for the patient. Opinion is divided regarding the relative risks and benefits of each procedure.

Objectives: 

To estimate the clinical effectiveness of surgical resection compared to biopsy in patients with a new presumptive diagnosis of HGG.

Search strategy: 

The following databases were searched for the update: Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3 2010 ), MEDLINE and EMBASE. The original search also included Cochrane Cancer Network (CCN), CancerLit, Biosis and Science Citation Index. Reference lists of all identified studies were searched. The Journal of Neuro-Oncology and Neuro-oncology were hand searched from 1999 to 2010 (including all conference abstracts). Neuro-oncologists were contacted regarding ongoing and unpublished trials. The searches were updated in 2003, 2007 and 29th October 2010.

Selection criteria: 

Patients included those of all ages with a presumed diagnosis of HGG based upon clinical and radiological investigation. Interventions included any form of biopsy or resection. Surgery was at the time of initial presentation and not for recurrence. Included studies had to be randomised controlled trials (RCTs).

Data collection and analysis: 

Two reviews authors independently assessed the search results for relevance and undertook critical appraisal according to pre-specified guidelines. Outcome measures include survival, time to progression/progression free survival, quality of life (QoL), symptom control, adverse events and mortality.

Main results: 

A single RCT of biopsy versus resection in presumed HGG was identified and is discussed in this review. No other articles met the inclusion criteria. Personal communication revealed an RCT of biopsy versus resection in the elderly with HGG due to commence in France in 2007 but by this 2010 update no further information is available regarding this trial.