SURG-07. CIRCUMFERENTIAL RESECTION OF GLIOBLASTOMA: A NOVEL SURGICAL TECHNIQUE FOR MAXIMISING EXTENT OF RESECTION AND PROLONGING SURVIVAL
Bibliographic record
Abstract
Evidence suggests that cytoreduction is associated with improved survival in glioblastoma (GBM) and that maximal, or gross total resection of the tumor offers the best chance for prolonged survival. We developed a novel surgical technique for removal of GBM called Circumferential resection during which we identify the interface between the enhancing rim of GBM and surrounding brain structures enabling more complete resection. We evaluate the impact of this method on extent of resection and survival in glioblastoma. We retrospectively evaluated 127 consecutive patients with newly diagnosed GBM treated at our institution. Forty-seven (37%) had circumferential resection (CR) by the senior author and the other 80(63%) had debulking/piecemeal (“non-circumferential”) resection(NCR). All patients underwent adjuvant chemoradiotherapy as per the Stupp protocol. Tumor volumetric analysis was performed using Osirix software. Overall survival and survival as stratified by treatment and extent of resection (EOR) were evaluated using Kaplan-Meier survival analysis. Clinical characteristics between CR and NCR cohorts were similar. Mean age at diagnosis was 59 years and 81(63.9%) were male. Pre-operative tumor volume was 31.8 cm3 vs. 40.6 cm3 (p=0.05) for CR vs. NCR respectively. Patients who had CR had higher median EOR (100.0 vs. 90.4, p<0.0001). The median OS for the entire cohort was 13.2 months. Median OS for CR and NCR was 17.7 and 11.0 months respectively (p<0.0001). EOR significantly impacted survival. Among the CR cohort, median survival was 22.5 and 11.5 months for >98% and <98% EOR respectively while median survival for the NCR cohort was 14.4 and 9.6 months for >98% and <98% EOR respectively. Post-operative Karnofsky Performance Scale (median, interquartile range) was 80(70-90) and 70(70-90) for CR and NCR patients respectively (p=0.43). Circumferential resection helps maximise the extent of resection in glioblastoma surgery and significantly prolongs survival without compromise to functional status.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".