Surgical Status in the Era of New Molecular Diagnostics: Insights from a Single-Center Case Series Report in China

Abstract

Background

With the publication of the "2016 WHO Classification of Tumors of the Central Nervous System," attention to the molecular and biochemical characteristics of brain tumors has increased among oncologists. Surgical biopsy provides valuable information on molecular markers of brain gliomas, aiding in further personalized treatment. This retrospective study aimed to elucidate the real-world application of surgery in Diffuse Intrinsic Pontine Glioma (DIPG) in the era of new molecular diagnostics.

Objective

To assess the surgical landscape in the treatment of DIPG patients from Jan 2017 to Feb 2023 at the Cancer Center of Guangdong Sanjiu Brain Hospital.

Method

Clinical data, including patient family consent for surgery, surgical procedure selection, complications, postoperative treatment, pathology findings, and survival outcomes, were retrospectively reviewed.

Results

From February 2017 to February 2023, Guangdong Sanjiu Brain Hospital's oncology department treated a total of 184 cases, with 108 patients (58.6%, 108/184) undergoing surgery. Medical records indicated that surgery was introduced and discussed with 97.2% (179/184) of patients, among whom 110 expressed a willingness to undergo surgery, and 108 eventually underwent the procedure. Of the completed surgeries, 65.8% (71/108) were open surgeries, and 34.2% (37/108) involved the use of the Rosa robot. Patient ages ranged from 2 to 61 years, with a median age of 9 years. Among patients aged 18 and above (n=60), 78.3% (47/60) underwent surgery, while among those below 18 years (n=124), 49.1% (61/124) underwent surgery, showing a statistically significant difference between the two groups (P<0.05). The median time from surgery to radiotherapy was 19 days for open biopsy and 7 days for stereotactic biopsy. In the open biopsy group, 20 patients experienced increased cranial nerve dysfunction from preoperative to postoperative, with three patients requiring ICU stays exceeding one month. All 108 patients obtained pathological diagnoses, with 79 cases being diffuse midline gliomas and 29 cases classified as other gliomas. The latter included 4 cases of pilocytic astrocytoma, 16 cases of grade 2 diffuse astrocytoma, 7 cases of grade 3 glioma, and 2 cases of pediatric glioblastoma. Seven patients received targeted therapy based on second-generation sequencing results, involving drugs such as ribociclib, rigosertib, cabozantinib, and ONC201.

Conclusion

In contrast to data from a decade ago, oncologists' willingness to perform brainstem surgery has increased. Surgical biopsy is more likely in older patients with brainstem lesions. Compared to open biopsy, stereotactic biopsy has fewer side effects and allows for rapid initiation of radiotherapy. Obtaining lesion tissue during surgery brings hope for new treatments and future research for patients.