{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:08:33Z","timestamp":1788847713335,"version":"build-2803163510"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Marlene and Dr. Dirk Ippen"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tumor resection is a prerequisite in many studies of new glioblastoma therapeutics; however, no clear parameters for \u201cresectability\u201d exist. We evaluated inter-rater variability in assessing tumor resectability and potential associations between resectability and survival in a trial cohort of glioblastoma recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>DIRECTOR (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 \u201cmeaningful resection\u201d was achievable for each recurrent IDH-wildtype glioblastoma based on imaging and clinical data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>MRI scans from 69 patients were available (median age: 58.2\u2009\u00b1\u20091.1 years, median survival: 10.0 months). Forty patients underwent re-resection (median age: 56.4\u2009\u00b1\u20091.7 years, median survival: 10.8 months). Surgical decision-making markedly varied between raters, ranging from 30 to 58 of 69 cases being classified as \u201cresectable\u201d (\u03ba\u2009=\u20090.405). In patients who received re-resection, a \u201cmeaningful resection\u201d was deemed feasible by &amp;gt;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 &amp;gt;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 &amp;gt;80% of raters was not associated with prolonged overall survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Feasibility assessment for re-resection is heterogeneous among neurosurgeons, challenging single-surgeon evaluation of \u201cresectability.\u201d Those findings are limited by the number of surgical raters and the size of the DIRECTOR cohort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuonc\/noag103","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T11:41:35Z","timestamp":1778154095000},"page":"2197-2210","source":"Crossref","is-referenced-by-count":0,"title":["Discrepancies in inter-rater agreement on resectability of recurrent glioblastoma: Complementary post-hoc analysis of the prospective, randomized DIRECTOR trial"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1254-5310","authenticated-orcid":false,"given":"Philipp","family":"Karschnia","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen, (P.K., N.T., O.S.)","place":["Germany"]},{"name":"Department of Neurosurgery, Ludwig-Maximilians-University , Munich,","place":["Germany"]},{"name":"German Cancer Consortium (DKTK), DFKZ Partner Site Munich , Munich, (P.K., N.T., J.-C.T.)","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7153-7994","authenticated-orcid":false,"given":"Nico","family":"Teske","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen, (P.K., N.T., 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