oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2017-16-4-54-64oncotomsk-567Research ArticleОБЗОРЫREVIEWSПРИМЕНЕНИЕ ФЛУОРЕСЦЕНТНОЙ НАВИГАЦИИ С 5-АМИНОЛЕВУЛИНОВОЙ КИСЛОТОЙ В ХИРУРГИИ ГЛИОБЛАСТОМЫ: МЕТААНАЛИЗINTRAOPERATIVE FLUORESCENCE-GUIDED RESECTION OF HIGH-GRADE GLYOBLASTOMA USING 5-AMINOLEVULINIC ACID: A META-ANALYSISБывальцевВ. А.ByvaltsevV. A.

Бывальцев Вадим Анатольевич - доктор медицинских наук, заведующий курсом нейрохирургии Иркутского государственного медицинского университета; главный нейрохирург «ОАО РЖД»; руководитель центра нейрохирургии НУЗ «Дорожная клиническая больница на ст. Иркутск-Пассажирский»; заведующий научно-клиническим отделом нейрохирургии Иркутского научного центра хирургии и травматологии; профессор кафедры травматологии, ортопедии и нейрохирургии Иркутской государственной медицинской академии последипломного образования.

664003, г. Иркутск, ул. Красного Восстания, 1.

Byvaltsev Vadim A., MD, DSc, Head of neurosurgery course, Irkutsk State Medical University; Chief Neurosurgeon, Head of Neurosurgery Center, Railway Clinical Hospital, Irkutsk; Head of Neurosurgery Department, Irkutsk Scientific Center of Surgery and Traumatology; Professor of the Department of Traumatology, Orthopedics and Neurosurgery, Irkutsk State Medical Academy of PostgraduateEducation.

1, Krasnogo Vosstaniya str., 664003-Irkutsk, Russia.

byval75vadim@yandex.ruСтепановИ. А.StepanovI. A.

Степанов Иван Андреевич - аспирант курса нейрохирургии, Иркутский государственный медицинский университет.

664003, г. Иркутск, ул. Красного Восстания, 1.

Stepanov Ivan A., post-graduate of the course of neurosurgery, Irkutsk State Medical University.

1, Krasnogo Vosstaniya str., 664003-Irkutsk, Russia.

edmoilers@mail.ruФГБОУ ВО «Иркутский государственный медицинский университет»; НУЗ «Дорожная клиническая больница на ст. Иркутск-Пассажирский»; ФГБНУ «Иркутский научный центр хирургии и травматологии»; ГБОУ ДПО «Иркутская государственная медицинская академия последипломного образования».РоссияIrkutsk State Medical University, Ministry of Health; Railway Clinical Hospital Irkutsk-Passazhirskiy of Russian Railways Ltd; Irkutsk Scientific Center of Surgery and Traumatology; Irkutsk State Medical Academy of Postgraduate Education.Russian FederationФГБОУ ВО «Иркутский государственный медицинский университет».РоссияIrkutsk State Medical University, Ministry of Health.Russian Federation2017120920171645464Copyright © Бывальцев В.А., Степанов И.А., 20172017Бывальцев В.А., Степанов И.А.Byvaltsev V.A., Stepanov I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/567

Глиобластома (ГБМ) является высокозлокачественной первичной глиальной опухолью головного мозга, которая характеризуется устойчивостью к современным методам лечения. Использование флуоресцентной навигации с 5-аминолевулиновой кислотой (5-АЛА-ФН) является современным методом интраоперационной навигации в хирургии ГБМ. Однако широкое применение флуоресцентной навигации приводит к развитию нежелательных явлений, что требует уточнения показаний к её использованию и строгого отбора пациентов. Цель исследования – определить клиническую эффективность, чувствительность и специфичность 5-АЛА-ФН в хирургии ГБМ. Материал и методы. Проведен метаанализ опубликованных с 2000 по 2017 г. клинических серий результатов хирургического лечения ГБМ, в которых использовалась 5-АЛА-ФН. Результаты и обсуждение. В метаанализ включены 25 зарубежных и 1 отечественное исследование. У 74,8 % пациентов (95 % ДИ: 67,4‑83,5 %) удалось достигнуть максимальной степени резекции опухоли. 5-АЛА-ФН увеличивает длительность безрецидивного периода (ДБП) у пациентов с ГБМ в среднем на 8,14 мес (95 % ДИ: 4,36–12,02). Разница в общей выживаемости пациентов с ГБМ при лечении с использованием 5-АЛА-ФН и без нее составляет 4,35–6,17 мес (95 % ДИ: 0,9–13,23). Использование 5-АЛА-ФН обладает высокой специфичностью – 86,6–87,5 % (95 % ДИ: 81,6–91,7) и чувствительностью – 79,8–82,2 % (95 % ДИ: 73,5–91,07) в отношении ГБМ. Заключение. Проведенный метаанализ 26 клинических серий, в которых при микронейрохирургическом удалении ГБМ использовалась 5-АЛА-ФН, показал, что данная методика обладает высокой степенью чувствительности и специфичности. Более того, использование 5-АЛА-ФН в хирургии ГБМ даёт значительные преимущества пациентам в отношении увеличения ДБП и степени резекции опухоли.

Background. Glioblastoma (GBM) is a high-grade primary brain tumor characterized by resistance to modern treatment modalities. Intraoperative fluorescence-guided resection using 5-aminolevulinic acid (5-ALA) is one of the most innovative techniques to improve the local control rate in GBM surgery. Objective: to assess the diagnostic accuracy, sensitivity and specificity of 5-ALA fluorescence- guided resection (5-ALA-FGR) in patients with GBM. Material and methods. Surgical outcomes of 5-ALA-FGR in patients with GBM were studied in a meta-analysis of clinical series published from 2000 to 2017. Results. The meta-analysis included 26 studies. Gross total tumor resection was achieved in 74.8 % of patients (95 % CI: 67.4–83.5 %). The use of 5-ALA-FGR increased the disease-free survival time in patients with GBM by an average of 8.14 months (95 % CI: 4.36–12.02). The difference in the overall survival of GBM patients in favor of 5-ALA-FGR was 4.35–6.17 months (95 % CI: 0.9–13.23). The specificity and sensitivity of 5-ALA-FGR was high, being 86.6–87.5 % (95 % CI: 81.6–91.7) and 79.8–82.2 % (95 % CI: 73.5–91.07), respectively. Conclusion. The meta-analysis of 26 clinical series showed the high sensitivity and specificity of 5-ALA-FGR. Moreover, the use of 5-ALA-FGR in GBM was reported to increase the disease-free survival and the extent of surgical resection in patients with GBM.

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The authors declare that there are no conflicts of interest present.