Discrepancies in inter-rater agreement on resectability of recurrent glioblastoma: Complementary post-hoc analysis of the prospective, randomized DIRECTOR trial.
Trial report in Neuro-oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00941460 (Dose-intensified Rechallenge With Temozolomide, One Week On One Week Off Versus Three Weeks On One Week Off in Patients With Progressive or Recurrent Glioblastoma), which is not on this map. Cited by 1 paper.
0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
2 · The registry
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Dose-intensified Rechallenge With Temozolomide, One Week On One Week Off Versus Three Weeks On One Week Off in Patients With Progressive or Recurrent Glioblastoma
TypeinterventionalSponsorProf. Dr. Wolfgang WickRan2009 to 2013Enrolled105ConditionsGlioblastomaArmsTemozolomide in both arms
Emilie Le RhunDepartment of Medical Oncology and Hematology, University Hospital and University of Zurich, Zurich, Switzerland (E.L.R.).ORCID 0000-0002-9408-3278
Hans-Georg WirschingDepartment of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (H.-G.W., M.W.).ORCID 0000-0001-6254-4204
Asgeir S JakolaDepartment of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.ORCID 0000-0002-2860-9331
Constantin RoderDepartment of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany.ORCID 0000-0003-4487-2807
Daniel P CahillDepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.ORCID 0000-0003-2552-6546
Einar O Vik-MoDepartment of Neurosurgery, Oslo University Hospital & Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Mitchel S BergerDepartment of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA.
Jacob S YoungDepartment of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA.ORCID 0000-0002-5499-4325
Wolfgang WickNeurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.ORCID 0000-0002-6171-634X
Ghazaleh TabatabaiDepartment of Neurology and Neuro-Oncology, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Center for Neurooncology, Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany (G.T.).ORCID 0000-0002-3542-8782
Joachim P SteinbachDr. Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany.ORCID 0000-0002-4695-2483
Bogdana SuchorskaDepartment of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany (B.S.).ORCID 0000-0002-1083-8232
Katharine J DrummondDepartment of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
Lorenzo BelloDivision for Neuro-Oncology, Department of Oncology and Hemato-Oncology, IRCCS Galeazzi Sant'Ambrogio, University of Milan, Milan, Italy.ORCID 0000-0001-6797-7105
Marike L D BroekmanDepartment of Neurosurgery, Haaglanden Medical Center, Leiden University Medical Center, Leiden, The Netherlands.ORCID 0000-0003-2205-5179
Michael A VogelbaumDepartment of Neurosurgery, Moffitt Cancer Center, Tampa, FL, USA.ORCID 0000-0002-9833-2374
Yoshua EsquenaziDepartment of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, USA.ORCID 0000-0002-9757-1453
Oliver SchnellDepartment of Neurosurgery, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany (P.K., N.T., O.S.).ORCID 0000-0002-1284-1427
Michael WellerDepartment of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (H.-G.W., M.W.).ORCID 0000-0002-1748-174X
Joerg-Christian TonnDepartment of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany.ORCID 0009-0004-1756-423X
Funding
UCSF Paul Calabresi K12 Career Development Program in Clinical OncologyK12CA260225 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI BERGSLAND, EMILY K, BIVONA, TREVER G · 2021 to 2025
$2.6M
NCI NIH HHS K12 CA260225
6 · The paper itself
Abstract
backgroundTumor resection is a prerequisite in many studies of new glioblastoma therapeutics; however, no clear parameters for "resectability" exist. We evaluated inter-rater variability in assessing tumor resectability and potential associations between resectability and survival in a trial cohort of glioblastoma recurrence.
methodsDIRECTOR (NCT00941460; 9/2009-6/2012) evaluated two dose-dense temozolomide regimens for first recurrent glioblastoma, yielding similar outcomes between arms. Re-resection was allowed before initiation of systemic therapy by institutional decision. Eleven surgical neuro-oncologists (blinded to final outcomes) rated whether a "meaningful resection" was achievable for each recurrent IDH-wildtype glioblastoma based on imaging and clinical data.
resultsMRI scans from 69 patients were available (median age: 58.2 ± 1.1 years, median survival: 10.0 months). Forty patients underwent re-resection (median age: 56.4 ± 1.7 years, median survival: 10.8 months). Surgical decision-making markedly varied between raters, ranging from 30 to 58 of 69 cases being classified as "resectable" (κ = 0.405). In patients who received re-resection, a "meaningful resection" was deemed feasible by >80% of raters in 30/40 cases (75.0%). For patients without re-resection, unanimous agreement on non-resectability occurred in only 3/29 cases (10.4%); and 5/29 tumors (17.2%) were considered resectable by >80% of raters. Knowledge of additional clinical factors virtually never changed MRI-based judgments. While patients who had a complete resection of contrast-enhancing tumor had favorable outcomes, a consensus on resectability by >80% of raters was not associated with prolonged overall survival. DISCUSSION: Feasibility assessment for re-resection is heterogeneous among neurosurgeons, challenging single-surgeon evaluation of "resectability." Those findings are limited by the number of surgical raters and the size of the DIRECTOR cohort.
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.
Discrepancies in inter-rater agreement on resectability of recurrent glioblastoma: Complementary post-hoc analysis of the prospective, randomized DIRECTOR trial. · full record | OpenQuestion