Feasibility, Safety and Impact on Overall Survival of Awake Resection for Newly Diagnosed Supratentorial -Wildtype Glioblastomas in Adults.

Background: Although awake resection using intraoperative cortico-subcortical functional brain mapping is the benchmark technique for diffuse gliomas within eloquent brain areas, it is still rarely proposed for IDH-wildtype glioblastomas. We have assessed the feasibility, safety, and efficacy of awake resection for IDH-wildtype glioblastomas.

Methods: Observational single-institution cohort (2012-2018) of 453 adult patients harboring supratentorial IDH-wildtype glioblastomas who benefited from awake resection, from asleep resection, or from a biopsy. Case matching (1:1) criteria between the awake group and asleep group: gender, age, RTOG-RPA class, tumor side, location and volume and neurosurgeon experience.

Results: In patients in the awake resection subgroup ( = 42), supratotal resections were more frequent (21.4% vs. 3.1%, < 0.0001) while partial resections were less frequent (21.4% vs. 40.1%, < 0.0001) compared to the asleep ( = 222) resection subgroup. In multivariable analyses, postoperative standard radiochemistry (aHR = 0.04, < 0.0001), supratotal resection (aHR = 0.27, = 0.0021), total resection (aHR = 0.43, < 0.0001), KPS score > 70 (HR = 0.66, = 0.0013), promoter methylation (HR = 0.55, = 0.0031), and awake surgery (HR = 0.54, = 0.0156) were independent predictors of overall survival. After case matching, a longer overall survival was found for awake resection (HR = 0.47, = 0.0103).

Conclusions: Awake resection is safe, allows larger resections than asleep surgery, and positively impacts overall survival of IDH-wildtype glioblastoma in selected adult patients.