Biopsy versus resection for malignant glioma (Cochrane Review)

A substantive amendment to this systematic review was last made on 23 February 2000. Cochrane reviews are regularly checked and updated if necessary.

Background: Patients with presumed primary supratentorial brain tumours have two surgical management options - biopsy or resection. Where there is severe raised intracranial pressure surgical resection is indicated. Where surgical resection is impossible biopsy is the only alternative. Most patients fall somewhere between these extremes and in these cases it is uncertain which offers the best surgical option for the patient. Surgical opinions appear equally divided when considering the relative risks and benefits of these procedures.

Objectives: To estimate the clinical effectiveness of surgical resection compared to simple biopsy in patients with malignant glioma.

Search strategy: We searched the following databases: CENTRAL, the Cochrane Cancer Network Register of Trials, MEDLINE, CANCERLIT, EMBASE, BIOSIS and SCIENCE CITATION INDEX. Reference lists of all identified studies were scanned; the Journal of Neuro-Oncology was hand searched from 1999 to 2002, including all conference abstracts. Neuro-oncologists were contacted regarding ongoing and unpublished trials.

Selection criteria: Randomized and clinical controlled trials (RCTs and CCTs) comparing biopsy with resection for patients of all ages with malignant glioma; studies of the effects of extent of resection on survival, time to progression or quality of life.

Data collection and analysis: The search results were assessed for relevance. Relevant studies were critically appraised and data extracted by one author.

Main results: One RCT of biopsy versus resection in presumed malignant glioma was identified, and it is discussed in this review. Two other articles were identified for possible inclusion, however both were excluded. The hand searching and personal communication were unproductive. One RCT of biopsy versus resection for malignant glioma is underway in Germany and another is being developed in the UK.

Reviewers' conclusions: Given that the only RCT was a single institution study of 23 patients with malignant primary brain tumours (out of 30 patients randomized), had inequalities between the two treatment groups and was under-powered to show a difference, it is not possible to establish whether one form of treatment is superior to another. The study highlights frequent radiological misdiagnoses (23% of suspected cases having an alternative diagnosis, half of which not cancer related). Further large multicentred RCTs are required to conclusively answer the question of whether prior to radiotherapy, resection or biopsy is superior.

Citation: Grant R, Metcalfe SE.. Biopsy versus resection for malignant glioma (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

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This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

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