re: GBM's

[nordarc]

Does any know of any papers on the subject of GTR of GBM's. Especially those that occur in the right frontal. More specifically a complete frontal loebctomy without even going into the tumour.

I am a 5th year NS resident in South Africa. I would like to hear from other residents all over the world and get to know of similrarities/disimilarairties that exist between our programs. When I am on call I do an avergae of six cases per (usually with 2 craniotomies for TBI). Is it the same as elsewhere?

---

Members don't see this ad.

 

[kitsunepixie]

I recommend posting this at Uncleharvey.com--there are far more neurosurgery residents on that forum than on here.

 

[Raygun77]

Does any know of any papers on the subject of GTR of GBM's. Especially those that occur in the right frontal. More specifically a complete frontal loebctomy without even going into the tumour.

I am a 5th year NS resident in South Africa. I would like to hear from other residents all over the world and get to know of similrarities/disimilarairties that exist between our programs. When I am on call I do an avergae of six cases per (usually with 2 craniotomies for TBI). Is it the same as elsewhere?

As far as i know- there have been no (and probably never will be) any trials adequately comparing GTR vs subtotal tumour resections and survival given how unethical it is. There are a CRAPLOAD of low-impact retrospective studies however. Here's a cochrane review on biopsy vs surgery:
http://www.cochrane.org/reviews/en/ab002034.html

and heres a review on extent of cytoreductive surgery;
http://www.springerlink.com/content/l5255x36v2661072/

I don't know of any studies of right frontal total lobectomies- those sure don't happen in Australia- but even with those margins i still think the bugger will come back .

I'd be interested in knowing a) what the side effects are, especially in left handed patients

b) what you irradiate after taking that much out- the resection cavity?

Cheers


It IS more or less accepted that GTR resections give much better quality of life (given reduced mass effect etc).

 

[BrodieDurden]

GBM is a whole brain disease. You could do a total frontal lobectomy and have another Phineas Gage and it still won't cure em. I've seen an occipital GBM that 'radiographically' was pretty much just in the occipital lobe. Patient donated brain and sections from the frontal lobe looked like a Grade III AA. Malignant cells go along the white matter to everywhere in the brain. Resection is purely palliative.

As for GTR, well there is research saying that Neural Stem Cells that become cancer stem cells are the cause of GBMs so GTR for already malignant cells wont work. Who knows. Lots of good research ongoing.