Emerging Imaging and Operative Techniques for Glioma Surgery
Notice bibliographique
Résumé
Malignant gliomas are the most common adult primary brain cancers and are amongst the most devastating of human malignancies. These cancers are characterized by high proliferation and invasion into normal brain. Treatment consists of a combination of surgery, radiotherapy, and chemotherapy. Despite years of experience and refinement of these treatments, patients suffering from World Health Organization grade four gliomas have a mean survival of 14 months The goal of surgery is to remove the entirety of the tumor as strong emerging evidence suggests that completeness of resection improves cancer control and lengthens survival. Extent of resection, for malignant gliomas, is based on gadolinium-enhanced magnetic resonance imaging (MRI). In cases of complete resection, radiotherapy is then delivered to a 2 cm border along the resection cavity. In cases of incomplete resection, radiotherapy is delivered to the residual tumor and a 2 cm border along the residual tumor and resection cavity. The rational for this radiotherapy strategy is that invasive cancer cells can be found up to 2 cm distant from the main tumor mass. Studies examining the location of malignant glioma recurrence following surgery and adjuvant radiotherapy and chemotherapy have found that most cancers recur within a 1 cm border along the surgical resection cavity, even in cases in which no residual gadoliniumenhancing tumor was evident on immediate post-operative MRI. This suggests that gadolinium-enhanced MRI does not sufficiently reveal the entire tumor resulting in residual tumor post-operatively. Other common MRI sequences, including FLAIR and T2, do not adequately distinguish non-gadolinium enhancing cancer cells from peritumoral edema. The inability to accurately visualize the whole tumor, including invasive cells, on imaging decreases the likelihood of complete resection. Recently, attempts to visualize malignant gliomas with newer imaging techniques, including metabolic labeled positron emission tomography (PET), have identified tumor borders beyond those seen with gadoliniumenhanced MRI. These technologies may have profound implications regarding surgical planning in malignant glioma surgery. Historically, extent of tumor resection has been determined by the surgeon's qualitative assessment at the time of operation, often reporting a gross total resection. More recently, the use of immediate post-operative MRI has revealed that complete resection of the gadolinium-enhancing portion of the tumor is achieved at a much lower rate. This overestimation by surgeons is, in part, owing to the difficulty distinguishing cancer cells www.intechopen.com Advances in Cancer Management 140 from normal brain. Since malignant gliomas are highly invasive tumors, the margin between tumor and normal brain is typically not obvious. Reluctant to cause an irreversible neurological deficit, surgeons will error on the side of caution. The downside is that malignant cancer cells will remain. Since adjuvant radiation and chemotherapies are only modestly effective Intraoperative tools designed to help surgeons distinguish cancer cells from normal brain include ultrasound and fluorescence guided surgical resection. Comparative studies using these tools have shown higher rates of complete resection compared to standard operating techniques. Here we review current and emerging imaging technologies designed to better visualize the tumor on preoperative imaging. We also review developing surgical technologies to help surgeons distinguish cancer cells from normal brain intraoperatively. The development of these technologies will lead to an increased rate of complete resection and thus improved cancer control.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».