Sub-lobectomy for IDH Wild-type and TERT Promoter Mutant Glioblastoma

Condition(s) studied

Investigational drug(s) / intervention(s)

sub-lobectomy: Combined with previous research and our team's precise neurosurgery concept, we define the surgical strategy based on lobectomy and further preserving the brain parenchyma in functional areas according to anatomical landmarks and electrophysiological boundaries as sub-lobectomy.

imaging total resection: Imaging total resection (T1-enhanced borders) will met the RANO criteria

Study summary

Glioblastoma is recognized as the most common and aggressive form of primary malignant brain tumor, with treatment options that are limited and prognosis that is extremely poor, showing median progression-free survival of 12 months and median overall survival of less than 18 months. Surgical resection plays a critical role in the treatment, with the extent of resection significantly impacting patient outcomes. Historical approaches to surgical resection have evolved, moving from radical strategies to more conservative ones that aim to preserve normal brain function while removing the tumor as completely as possible. Recent studies have suggested that increasing the extent of surgical resection, particularly along the T2 FLAIR border rather than the traditional T1-enhanced border, can significantly improve patient prognosis. There is, however, a lack of consensus on the optimal surgical approach, and the heterogeneity of tumors presents challenges in standardizing surgical strategies. Extended resection has been shown to prolong survival, and novel intraoperative molecular diagnostics have emerged to improve accuracy in tumor classification and prognosis. Building on these advancements, a multicenter, prospective, randomized controlled trial is proposed to evaluate the efficacy of sub-lobectomy in treating IDH wild-type/TERTp-mutant glioblastoma, aiming to improve evidence levels and establish standardized surgical practices for this devastating disease.

Eligibility

Primary outcome measure(s)

• Progression-free Survival — From date of randomization until the date of first documented progression, assessed up to 36 months
  Progression-free Survival (PFS) in patients with IDH wild-type/TERTp-mutant glioblastoma in the sub-lobectomy group and in the imaging total resection (T1-enhanced border) group.

Trial sites (1)

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