Glioblastoma multiforme (GBM) is the most common primary brain tumor and remains uniformly fatal despite extensive surgical, medical, and radiation therapy. Gross total resection (GTR) with negative tumor margins is widely believed to improve treatment outcomes in surgical oncology. However, the unique constraints of the anatomy of the brain make GTR difficult and increase the risk of injury to eloquent brain structures, leading to significantly reduced quality of life. Furthermore, GBM is diffusely infiltrative and invades multiple lobes and often both cerebral hemispheres,1,2 Lack of widespread evidence from existing literature about the optimal extent of resection (EOR) has resulted in an absence of uniform practice guidelines, with differences of opinion on the true risks and benefits of GTR over subtotal resection (STR).
To determine the effect of EOR on 1- and 2-year overall survival (OS) and 6-month and 1-year progression-free survival (PFS), Brown et al3carried out a systematic review and meta-analysis of available literature from the past 5 decades in the PubMed, CINAHL, and Web of Science databases. Articles with adult newly diagnosed supratentorial GBM comparing EOR and providing objective OS and PFS data were included; pediatric studies were excluded. The American Academy of Neurology level of evidence criteria (grade I, most robust, to grade IV, weakest evidence) was used to classify the strength of evidence of individual studies, and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE)4 system was used to evaluate the overall body of evidence.
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