LAUSR

The concept for maximal resection of glioblastoma(GBM) is changing to resect not only contrast-enhanced (CE) tumor but non-contrast-enhanced (NCE) tumor. Although maximal resection is associated with longer survival, the pattern of recurrence in glioblastoma, isocitrate dehydrogenase (IDH)-wildtype patient is poorly understood. This retrospective, single-center study included 358 eligible patients through November 1, 2005 to December 31, 2018. Those patients were grouped along extent of resection (subtotal resection (STR, n=123), gross-total resection (GTR, n=194), and supratotal resection (SupTR, n=41)). The pattern of recurrence was classified based on the range of radiation treatment, into infield gross target volume (GTV), infield clinical target volume (CTV), marginal, outfield and CSF seeding. Tumor recurrence was observed for each group as follows: STR group, 80.5%, GTR group, 75.3%, and SupTR group, 63.4%. Statistical differences in pattern of recurrence among each group were observed in infield GTV (STR group:75.8%, GTR group: 71.9%, and SupTR group: 42.3%, p=0.003) and Outfield (STR group:11.0%, GTR group: 21.2%, SupTR group: 34.6%, p=0.012) recurrence. The survival for SupTR group was significantly longer than that for the STR and GTR in terms of both overall survival (OS) and progression free survival (PFS) (OS, STR: 15.7m, GTR: 21.6m, SupTR: 44.7m, PFS, STR: 10.4m, GTR: 14.3m, SupTR: 35.5m) As the extent of resection increased, local recurrence decreased and distant recurrence increased. During treatment of glioblastoma, expectation