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Biopsy versus resection for high grade gliomaHart MG, Grant R, Metcalfe SE
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SummaryMalignant gliomas are aggressive tumours of the nervous system, the management of which is usually palliative. Resection 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 optionOne small randomised controlled trial (RCT) addressing this question was found but the trial proved inadequate in design to answer the question conclusively. Larger well designed RCTs are required.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 24. 2000 AbstractBackgroundPatients with a presumed primary brain tumour from clinical examination and radiological investigation have two initial surgical management options; biopsy or resection. In certain acute situations such as severe raised intracranial pressure, surgical resection is clinically indicated. Where surgical resection is not practical, biopsy is the only reasonable option. Most patients fall somewhere between these extremes, and in these cases 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. ObjectivesTo estimate the clinical effectiveness of surgical resection compared to biopsy in patients with a new lesion suspicious of malignant glioma. Search strategyThe following databases were searched: Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Cancer Network Register of Trials, MEDLINE, EMBASE,CANCERLIT, BIOSIS and SCIENCE CITATION INDEX. Reference lists of all identified studies were searched. The Journal of Neuro-Oncology was hand searched from 1999 to 2007, including all conference abstracts. Neuro-oncologists were contacted regarding ongoing and unpublished trials. The search was updated in 2003 and January 2007. Selection criteriaPatients included those of all ages with a presumed diagnosis of malignant glioma from clinical examination and radiology. Interventions included biopsy or resection of any form. Surgery was at the time of initial presentation and not for recurrence. Included studies have to be RCTs. Outcome measures include survival, time to progression, quality of life (QOL), symptom control, morbidity and mortality. Data collection and analysisThe search results were assessed for relevance. Critical appraisal and data extraction was undertaken by two authors. Main resultsOne RCT of biopsy versus resection in presumed malignant glioma was identified, and it is discussed in this review (Vuorinen 2003). Ten other articles were identified for possible inclusion however all failed to meet selection criteria and were excluded. The hand searching was unproductive, although personal communication revealed an RCT of biopsy versus resection in the elderly with HGG is due to commence in France in early 2007. Authors' conclusionsThere is no high quality evidence with which to base management decisions on. The single RCT for biopsy versus resection in malignant glioma is inadequate to reach conclusions from, due to under-powering and other methodological shortcomings. Further large multi-centred RCTs are required to conclusively answer the question of whether biopsy or resection is superior. |