In an analysis from the GLIOMAP study reported in The Lancet Oncology, Gerritsen et al found that awake craniotomy for glioblastoma in eloquent brain areas (essential areas for carrying out basic neurological functions) was associated with reduced risk of neurologic deficits and improved survival outcomes compared with asleep resection.
Study Details
A propensity score–matched analysis was performed within a cohort of adult patients who underwent resection for primary eloquent glioblastoma at one of four centers between January 2010 and October 2020. A total of 134 patients who underwent awake mapping during resection were matched 1:3 with 402 who underwent asleep resection. The primary outcome measures were neurologic deficits (measured by deterioration in National Institute of Health Stroke Scale [NIHSS] score) and progression-free and overall survival.
Key Findings
In the awake group vs the asleep group, mean residual tumor volume was lower (1.9 mL vs 5.9 mL, P < .0001) and mean extent of resection was greater (95.4% vs 86.3%, P < .0001).
Among evaluable patients, neurologic deficits were observed in 26 (22%) of 120 patients in the awake group vs 107 (33%) of 323 in the asleep group at 3 months postsurgery (P = .019) and in 30 (26%) of 115 vs 125 (41%) of 305 at 6 months (P = .0048).
Median overall survival was 17.0 months (95% confidence interval [CI] = 15.0–24.0 months) in the awake group vs 14.0 months (95% CI = 13.0–16.0 months) in the asleep group (P = .00054). Median progression-free survival was 9.0 months (95% CI = 8.0–11.0 months) in the awake group vs 7.3 months (95% CI = 6.0–8.8 months) in the asleep group (P = .0060).
In subgroup analysis for neurologic deficits, significantly lower rates in the awake group vs the asleep group at 3 and 6 months were observed for patients aged < 70 years, those with a baseline NIHSS score of 0 or 1, and those with a baseline Karnofsky Performance Score (KPS) of 90 to 100. Significantly lower rates in the awake group were observed at 3 months in patients aged ≥ 70 years and those with a NIHSS score of ≥ 2, and at 6 months in those with a KPS of ≤ 80.
In subgroup analysis of survival outcomes, both overall survival and progression-free survival were significantly better in the awake group for patients aged < 70 years, those with a NIHSS score of 0 or 1, and those with a KPS of 90 to 100. No significant differences in overall survival or progression-free survival were observed among patients aged ≥ 70 years, those with a NIHSS score of ≥ 2, or those with a KPS of ≤ 80.
The investigators concluded, “These data might aid neurosurgeons with the assessment of their surgical strategy in individual glioblastoma patients. These findings will be validated and further explored in the SAFE trial (NCT03861299) and the PROGRAM study (NCT04708171).”
Jasper K.W. Gerritsen, MD, of the Department of Neurosurgery, Erasmus Medical Center, Rotterdam, is the corresponding author for The Lancet Oncology article.
Disclosure: For full disclosures of the study authors, visit thelancet.com.
