Anterior Temporal Lobectomy in Temporal Glioblastoma

Launched by UNIVERSITY HOSPITAL, BONN · Jun 7, 2025

Keywords

ClinConnect Summary

The ATLAS/NOA-29 trial is studying a new surgical approach called anterior temporal lobectomy (ATL) for patients with a type of brain tumor known as glioblastoma that is located in the front part of the temporal lobe. This trial compares ATL to a standard surgery method called gross-total resection (GTR) to see if ATL can help patients live longer and maintain a good quality of life. Patients who take part in this study will be randomly assigned to receive either surgery method after their diagnosis is confirmed during the operation. The goal is to enroll 178 patients over three years and follow them for at least three years to gather important information about their survival and recovery.

To be eligible for this trial, participants need to be between 18 and 75 years old and have a brain tumor that’s causing symptoms. They must also be in good overall health and have a reasonable life expectancy. Patients will need to provide informed consent, which means they understand the study and agree to participate. Throughout the trial, researchers will monitor how well the surgery works and how it affects life quality, including aspects like cognitive function and seizure control. This study could lead to new insights into the best surgical methods for treating glioblastoma, potentially improving outcomes for future patients.

Gender

ALL

Eligibility criteria

• • Suspected glioblastoma with contrast-enhancement in preoperative MRI
• • Diffuse high-grade glioma in frozen section procedure, newly-diagnosed
• • Tumor localization (in gadolinium-enhanced MRI): solely temporal, non-dominant side (right hemisphere in right-handed patients, or left-handed patients after testing for dominance): within 6.5 cm from the temporal pole; dominant side (left hemisphere in right-handed patients, all left-handed patients unless additional testing for dominance performed): within 4.0 cm from the temporal pole, as determined dorsally along the Sylvian fissure.
• • Macroscopic complete resection (no remaining contrast-enhancing tumoral lesion on early postoperative MRI) is achievable (decision of the treating neurosurgeon)
• • In case further T1-contrast-enhancing and/or T2/FLAIR lesions are detected beyond the resection margins (6.5 cm on the non-dominant side and 4.0 cm on the dominant side), these lesions are not attributed to the tumor (except perifocal edema) but to other conditions according to the local treating neurosurgeon
• • ≥ 18 and \< 75 years of age
• • KPS ≥ 70%
• • Estimated life expectancy of at least 6 months
• • Written informed consent
• • Cognitive state to understand the rationale and necessity of the study therapy and procedures
• • Patient compliance and geographic proximity that allow adequate follow-up
• • For patients with childbearing potential: negative serum pregnancy test (beta-HCG) at baseline visit, patient's commitment to use an approved contraceptive method during the trial and for 3 months after (Pearl index \< 1%)
• * Adequate organ function at baseline visit that does not preclude alkylating chemotherapy and neurosurgical procedures (all criteria required):
• • Adequate bone marrow reserve: white blood cell (WBC) count ≥ 3.000/µl; granulocyte count \> 1.500/µl; platelets ≥ 100.000/µl; haemoglobin ≥ 10 g/dl
• • Adequate liver function: bilirubin \< 1.5 times above upper limit of normal range (ULN); alanine transaminase (ALT/SGPT) and aspartate transaminase (AST/ALAT) \< 3 times ULN
• • Adequate renal function: creatinine \< 1.5 times ULN
• • Adequate blood clotting: Partial Thromboplastin Time (PTT) not exceeding the upper limit of normal range and International Normalized Ratio (INR) \<1.5; in case of intake of anticoagulant medication or platelet function inhibitors, the coagulation analysis must show no detectable effect in specific blood tests (as described below) at the time of surgery, and discontinuation of the anticoagulant medication must be justifiable for at least 1 week postoperatively
• • Direct acting oral anticoagulants (e.g., rivaroxaban, apixaban, edoxaban, dabigatran): anti-Factor Xa (aFXa)-activity within the normal range (rivaroxaban, apixaban, edoxaban), TT/TCT (thrombin clotting time) or ecarin clotting time (ECT) not exceeding the upper limit of normal range (Dabigatran) or verification of subtherapeutic drug levels (apixaban, edoxaban, rivaroxaban, dabigatran)
• • Vitamin K antagonists (coumarins): INR \< 1.5
• • Unfractionated heparin (UFH) and argatroban: activated Partial Thromboplastin Time (aPTT) not exceeding the upper limit of normal range
• • Fractionated heparin/low-molecular-weight heparin (e.g., dalteparin, enoxaparin), heparinoid (e.g., fondaparinux, danaparoid): aFXa-activity within the normal range
• • Antiplatelet agents (aspirin, clopidogrel, prasugrel, ticagrelor): platelet function analyzer (PFA) test not exceeding the upper limit of normal range (aspirin), whole blood aggregometry not below lower limits of normal range (clopidogrel, prasugrel, ticagrelor)
• • For details see study protocol.