Research on Establishing a Standard Surgical Method for Glioblastoma

Professor

SONODA Yukihiko

Glioblastoma is one of the most challenging brain tumors to treat. The current standard treatment consists of surgical resection followed by radiation therapy and chemotherapy; however, the median survival remains only about one and a half years.

Surgical planning is based on preoperative MRI, and the standard surgical approach is to remove the contrast-enhancing area observed on contrast-enhanced T1-weighted MRI. However, it is well known that glioblastoma cells also infiltrate the surrounding FLAIR high-signal areas, which do not enhance with contrast.

While postoperative radiation therapy targets these FLAIR high-signal areas, its efficacy is limited, and most recurrences are known to arise from this region.

In recent years, a new surgical technique called “FLAIRectomy” has been reported, in which not only the contrast-enhancing region but also the surrounding FLAIR high-signal areas are resected (Figure 1). However, it remains unclear whether this extended resection can be performed safely and whether it actually leads to better outcomes.

To address this, the Department of Neurosurgery at Yamagata University Faculty of Medicine, in collaboration with the Japan Clinical Oncology Group (JCOG) and approximately 40 institutions, is currently conducting a clinical trial to compare the effectiveness of resecting only the contrast-enhancing area versus resecting both the contrast-enhancing and surrounding FLAIR high-signal regions (Figure 2).

The results are expected in three to four years. Through this study, Yamagata University aims to generate new evidence toward establishing a more effective standard surgical approach for glioblastoma.

▲Figure 1:Overview of the JCOG2209 Clinical Trial

▲Figure 2: Extended Resection for Glioblastoma
Left: Preoperative contrast-enhanced MRI showing a ring-enhancing lesion indicating the tumor.
Right: Postoperative MRI showing that not only the ring-enhancing area but also the surrounding FLAIR high-signal area has been widely resected.