Wait Time Until Surgical Resection After an MRI Reveals a Lesion Concerning for Glioblastoma

Introduction: Currently, guidelines for resection timing following an initial glioma diagnosis do not exist. In diagnoses made outside of a tertiary care medical center, this is of particular interest due to resource availability and risk stratification. This study aimed to evaluate outcomes pertaining to time to surgery (TTS).

Methods: A total of 105 high-grade gliomas (HGGs), resected from January 17, 2014, to December 29, 2015, were retrospectively analyzed. Contrast-enhancing volumes were measured on initial (CEVI) and pre-operative (CEVPr) MRIs. Specific growth rate (SGR), which quantifies volumetric growth per day (%/day), equals ln(CEVPr/CEVI)/TTS X 100.

Results: Overall, the median (IQR) TTS was 11 (4, 24) days. Median CEVI and CEVPr were larger in those with a TTS < 7 days (37 [23.5, 55.6] vs. 13.8 [7.8, 25.8] cm3; P<.001) and (37 [22.2, 56.6] vs. 18.05 [9.5, 31.7] cm3; P<.001), respectively. However, CEVI and CEVPr were only significantly different in those with a TTS ≥7 (P=.02). Median SGR in those with a TTS of 7 to 21 and ≥ 21 days were 0.05%/day (-2.2, 1.4) and 0.81%/day (0.04, 2.19), respectively (P=.02). Overall, median EOR and OS were 96.8% (89.8, 100) and 13.5 (12, 16.2) months, respectively. While neither outcome was significantly affected by TTS or SGR, a greater EOR offered a survival advantage (HR, 0.2; 95% CI, 0.04, 0.93; P=.04). Lastly, neither TTS nor SGR had a significant effect on PFS, discharge to home, or postoperative KPS.

Conclusion : Although SGR was greater in those with an increased TTS, neither variable significant impacted surgical outcome. These results suggest that, even for MRI lesions concerning for HGG, patients do not require emergent surgical resection in the absence of clinical deterioration. Instead, they can be safely referred to high volume centers. Nonetheless, additional prospective studies are needed to validate these findings and guide future clinical practice.