Intra-operative Monitoring with Electrocorticography Associates with Improved Survival Outcomes in High-grade Glioma
Ryan Rilinger1, Lydia Guo1, Akshay Sharma2, Josephine Volovetz2, Matthew Grabowski2, Mina Lobbous3
1Cleveland Clinic Lerner College of Medicine, 2Department of Neurosurgery, 3Department of Neuro-Oncology, Cleveland Clinic Foundation
Objective:
We characterize the impact of intra-operative monitoring (IOM) with electrocorticography (ECoG) on post-operative outcomes in patients undergoing resection of high-grade gliomas (HGG) to clarify the benefits of ECoG as a cortical mapping tool in the context of HGG resection.
Background:
Maximal safe resection is recommended as first-line treatment whenever possible in HGG. Prior research demonstrates a clear survival benefit for patients who receive a gross total resection (GTR) of their primary tumor. ECoG, a form of IOM used frequently in epilepsy surgery, has recently grown in popularity to promote maximal safe resection of brain tumors located in eloquent cortex. However, it has not known whether the use of ECoG confers additional clinical benefits to patients beyond increasing the likelihood of a GTR.
Design/Methods:
We identified 648 patients with HGG who underwent surgical resection of their primary tumor; 311 patients had co-occurring epileptic activity. The Mann-Whitney U test compared median overall survival (OS) and progression-free survival (PFS) between patients with and without ECoG. Multivariable linear regression was used to assess the relationship between ECoG and post-operative outcomes (survival and seizure remission) while controlling for several additional variables, including age, anticancer treatments, gross total resection, and tumor location (lobe).
Results:
Median OS was significantly longer in patients who received ECoG (16.3 versus 14.0 months, P = 0.047). The association between ECoG and prolonged OS persisted in a multivariable linear regression (p = 0.013); no associations were seen with PFS. Although 80.6% of patients with tumor-associated epilepsy and ECoG achieved seizure remission compared to 71.7% without ECoG, this difference was not statistically significant (p = 0.260).
Conclusions:
The inclusion of ECoG during primary tumor resection in HGG associates with improved OS, even when accounting for tumor location and extent of tumor resection. ECoG may confer benefits during HGG primary tumor resection beyond facilitating the achievement of GTR.
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