Intraoperative B-Mode Ultrasound Guided Surgery and the Extent of Glioblastoma Resection: A Randomized Controlled Trial

Fatih Incekara; Marion Smits; Linda Dirven; Eelke M Bos; Rutger K Balvers; Iain K Haitsma; Joost W Schouten; Arnaud J P E Vincent

doi:10.3389/fonc.2021.649797

Intraoperative B-Mode Ultrasound Guided Surgery and the Extent of Glioblastoma Resection: A Randomized Controlled Trial

Front Oncol. 2021 May 19:11:649797. doi: 10.3389/fonc.2021.649797. eCollection 2021.

Authors

Fatih Incekara^{1

2}, Marion Smits², Linda Dirven^{3

4}, Eelke M Bos¹, Rutger K Balvers¹, Iain K Haitsma¹, Joost W Schouten¹, Arnaud J P E Vincent¹

Affiliations

¹ Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
² Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
³ Department of Neurology, Leiden University Medical Center, Leiden, Netherlands.
⁴ Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands.

Abstract

Background: Intraoperative MRI and 5-aminolaevulinic acid guided surgery are useful to maximize the extent of glioblastoma resection. Intraoperative ultrasound is used as a time-and cost-effective alternative, but its value has never been assessed in a trial. The goal of this randomized controlled trial was to assess the value of intraoperative B-mode ultrasound guided surgery on the extent of glioblastoma resection.

Materials and methods: In this randomized controlled trial, patients of 18 years or older with a newly diagnosed presumed glioblastoma, deemed totally resectable, presenting at the Erasmus MC (Rotterdam, The Netherlands) were enrolled and randomized (1:1) into intraoperative B-mode ultrasound guided surgery or resection under standard neuronavigation. The primary outcome of this study was complete contrast-enhancing tumor resection, assessed quantitatively by a blinded neuroradiologist on pre- and post-operative MRI scans. This trial was registered with ClinicalTrials.gov (NCT03531333).

Results: We enrolled 50 patients between November 1, 2016 and October 30, 2019. Analysis was done in 23 of 25 (92%) patients in the intraoperative B-mode ultrasound group and 24 of 25 (96%) patients in the standard surgery group. Eight (35%) of 23 patients in the intraoperative B-mode ultrasound group and two (8%) of 24 patients in the standard surgery group underwent complete resection (p=0.036). Baseline characteristics, neurological outcome, functional performance, quality of life, complication rates, overall survival and progression-free survival did not differ between treatment groups (p>0.05).

Conclusions: Intraoperative B-mode ultrasound enables complete resection more often than standard surgery without harming patients and can be considered to maximize the extent of glioblastoma resection during surgery.

Keywords: extent of resection; glioblastoma; image guided neurosurgery; intraoperative ultrasound; randomized controlled trial.

Associated data

ClinicalTrials.gov/NCT03531333