Introduction: The extent of resection is important to improve survival in patients with a glioblastoma. The neurosurgeon’s aim is to maximize the extent of resection, while preserving functional integrity. A standard to assess and compare the quality of neurosurgical care of teams is lacking. In this study we present a novel volumetric method to quantify post-resection residual tumors throughout the brain for patient populations. This allows direct comparison of surgical results between care teams.
Methods: All adults with first-time glioblastoma surgery in 2012-2013 in each of two Dutch and one United States tertiary referral centres for neuro-oncological care were included in this study. From each of these patient populations preoperative tumors and postoperative residual disease were segmented on MRI and registered to standard space. Brain maps of tumor and residual tumor locations were constructed for each country. Differences between these brain maps were analysed to explore patient selection and treatment variation.
Results: The study cohort consisted of 374 patients who received neurosurgery; 268 patients were treated by the Dutch care teams, 106 by the United States care team. 106 tumors were biopsied and 268 resected. Preliminary analyses show that tumor localization maps illustrate established preferential sites for glioblastoma distributions for each cohort, indicating similar patient referral patterns, selection or recruitment. Resection probability maps demonstrate no differential residual tumor localization throughout the brain, indicating similar surgical decision making. Brain maps were reviewed by the care teams and arguments for future decision making were discussed.
Conclusions: Brain maps of tumor localization convey important information that can be used to compare neurosurgical care teams in terms of patient selection. In addition, surgical decision making can be made explicit through resection probability maps. This novel volumetric approach can provide objective arguments for discussions between care teams on the quality of neurosurgical care for patients with a glioblastoma.
Patient Care: In this study we present for the first time that quality of glioblastoma resections can be compared between surgical teams using volumetric imaging analysis. We believe that these brain maps will provide objective arguments for discussions between care teams on the quality of neurosurgical care for the individual patient with a glioblastoma. We expect that multidisciplinary decision making will improve from this standardization of quality assessment, which ultimately could lead to standardization of neurosurgical care for these patients. We believe that this methodology could therefore be of high potential for the individual glioblastoma patient to obtain the best quality of care and subsequently best quality of life during their already short life expectancy.
Learning Objectives: Standards to assess and compare surgical decision making between neurosurgical care teams treating patients with a glioblastoma are lacking. Hence, patients might be subject to differential patient selection or treatment variation, which could lead to differences in quality of care. By the conclusion of this session, participants should be able to 1) understand the essence of providing the optimal form of care for the individual patient with a glioblastoma, 2) use volumetric imaging analysis by brain maps to evaluate and compare their quality of care with other neurosurgical care teams, 3) use this new knowledge for self-evaluation and future guidance in neurosurgical strategy for the patient with a glioblastoma, providing the most optimal neurosurgical care.