Biopsy versus resection for high grade glioma

Michael G Hart, Sarah Elizabeth Metcalfe, Robin Grant, Gareth RL Grant, Emma F Solyom, David G Grosset

Patients with isolated supratentorial brain tumours, presumed to be primary on imaging, have two surgical management options - biopsy or resection. Surgical opinions appear to be equally divided when considering the relative risks and benefits of these two procedures. To estimate the clinical effectiveness of radical surgical resection compared to simple biopsy in patients with malignant glioma. Electronic database searches of COCHRANE CONTROLLED TRIALS REGISTER (including the Cochrane Cancer Network Specialised Register of Trials), MEDLINE, CANCERLIT, EMBASE, BIOSIS and SCIENCE CITATION INDEX. Hand searching the references of all identified studies; hand searching the Journal of Neuro-Oncology over the previous 10 years, including all conference abstracts; personal communication. Randomised and clinical controlled trials were included if they compared biopsy to resection, or looked at effect of extent of resection on survival, time to progression or quality of life, for malignant glioma patients of all ages. Studies were to be identified, critically appraised and data extracted by the author (SEM). Ideally hazard ratios for overall survival were to be calculated along with the estimates of odds ratios from the percentage survival at one and two years. For dichotomous data, Peto odds ratios (OR) with 95% confidence intervals (CI) were hoped to have been estimated. Normal continuous data were to have been summated using the weighted mean difference (WMD). The electronic database search yielded 2100 citations. Of these, two articles were identified for possible inclusion, however both were excluded. The hand search and personal communication were similarly unproductive. No studies were included in the review and no data was synthesised. Given that no qualifying studies were identified and because this is an important issue, both in terms of patient risk and benefit and health economics, the authors feels it important to conduct a randomised controlled trial in this subject.