All patients with a brain lesion were divided into glioma and non-glioma cases depending on evaluation of initial presenting MRI scan with only suspected glioma patients undergoing subsequent functional MRI scans. According to this algorithm we graded glioma patients on the basis of a four part procedure consisting of a pre-operative, histological, surgical and a postoperative step ( Fig. Therefore, we compared a novel classification system with an established one in order to develop a neuro-oncological classification tool with prognostic value. Tumor localization and hence surgical accessibility are critical to successfully maximizing the extent of tumor resection. ![]() We describe a bipartite functional grading system (Friedlein grading A/B: FGA/B) based on functional topography aimed at creating a high degree of compliance for neuro-oncologists.Įstablishment of FGA/B as a novel prognostic classification system It is therefore clear that an easily accessible and dependable classification system is required meeting the needs for a pre- and postoperative tumor stratification accurately reflecting feasibility of resection. Thus, pre-operative tumor localization and subsequent operability is an important stratification parameter for proper clinical trials, something further complicated by considerable differences in individual surgical skill and center-specific state-of-the-art equipment 16, 17, 18, 19, 20. An important role behind this discrepancy can be traced back to patient distribution patterns based on an inherently heterogeneous tumor localization, which exerts a dramatic influence on the outcome of surgery with direct consequences for postoperative clinical course 8, 15. Whether such radical tumor resection exerts an influence on overall survival time was controversially discussed for a long time with some studies indicating no influence and others showing a positive correlation 9, 10, 11, 12, 13, 14. Maximizing cytoreduction by tumor resection through novel neurosurgical techniques still represents the first line therapy for glioma patients, with current trends focusing on the development of increasingly tailored treatment options with integration of molecular strategies in an attempt to at least maximize patient survival time and improve quality of life 6, 7, 8.Ī complete tumor resection has usually been understood to imply removal of the pre-operatively defined contrast-enhancing tumor portions. Although a cure remains elusive despite implementation of all currently available treatment options including radical surgical resection of the tumor mass followed by adjuvant radio-chemotherapy, this strategy serves to secure a histological diagnosis and improves response rates for radio-chemotherapy 4, 5. Amongst them, glioblastoma (GBM, WHO°IV) carries the worst prognosis with patients succumbing after a median survival time of 14 months 3. Gliomas are primary CNS tumors accounting for almost 80% of all diagnosed tumors of the brain originating from brain parenchyma, with malignant gliomas constituting the most common brain tumors in adults 1, 2. The FGA/B grading method provides high prognostic value with respect to overall survival time in relation to the extent of location-dependent tumor resection. ![]() We offer the opportunity to classify brain tumors in a dependable and reproducible manner. ![]() Investigation of outcome revealed that FGA were characterized by a significantly longer overall survival time compared to FGB. We performed a clinical investigation comprising 322 patients with gliomas and developed a novel classification system of preoperative tumor status, which considers tumor operability based on two graduations (Friedlein Grading - FG): FGA with lesions at safe distance to eloquent regions which can be completely resected and FGB referring to tumors which can only be partially resected or biopsied. ![]() Despite existing assessment methods, the availability of a simple but reliable preoperative grading based on functional data would therefore prove to be indispensable for the prediction of postoperative outcome and hence for overall survival in glioma patients. Consideration of tumor localization in relation to functionally eloquent brain areas has been gaining increasing importance. Surgical treatment is accepted to be the first line of therapy, with recent studies revealing that maximal possible tumor reduction exerts significant impact on patient outcome. Despite advances in multimodal treatments, malignant gliomas remain characterized by a short survival time.
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