Pilot RCT study to assess feasibility of "supra-marginal" surgical resection of malignant glioma (G-SUMIT: Glioma Supra Marginal Incision Trial)

Majority of neurosurgeons agree that removing more tissue of malignant brain tumor will lead to better survival. These tumors are infiltrative and usually don't have sharp defined margin between tumor and normal brain. However, there is currently no consensus on the how far surgical tissue removal should be pursued in various part of brain. This is because of concern about risk of more aggressive surgery. This is a small study to show ability to perform larger study testing best surgical principle in terms of extent of malignant brain tumor removal. It will mainly look at the ability to enrol and collect complete data on a pre-specified number of patients, while following their response in terms of controlling tumor recurrence and documenting any added risk to patient as the result of surgical complications. The study is performed at 7 Canadian hospitals. Patients that are suitable for study will be randomly divided into two groups: 1) usual practice of removing all visible tumor (defined by enhancement) on imaging and 2) more aggressive tumor removal about 1 cm beyond visible tumor on imaging. As this is small-scale study, it only has power to test the ability to collect enough patients, perform study accurately, and collect results. The result of this study is important to help to better design a larger similar study to answer a common clinical question in management of patients with aggressive brain cancer. It will aim to inform on clinical practice and future guidelines on surgical removal of these tumors.