INTRAOPERATIVE FLUORESCENCE-GUIDED RESECTION OF HIGH-GRADE GLYOBLASTOMA USING 5-AMINOLEVULINIC ACID: A META-ANALYSIS
https://doi.org/10.21294/1814-4861-2017-16-4-54-64
Abstract
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.
About the Authors
V. A. ByvaltsevRussian Federation
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 Postgraduate
Education.
1, Krasnogo Vosstaniya str., 664003-Irkutsk, Russia.
I. A. Stepanov
Russian Federation
Stepanov Ivan A., post-graduate of the course of neurosurgery, Irkutsk State Medical University.
1, Krasnogo Vosstaniya str., 664003-Irkutsk, Russia.
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Review
For citations:
Byvaltsev V.A., Stepanov I.A. INTRAOPERATIVE FLUORESCENCE-GUIDED RESECTION OF HIGH-GRADE GLYOBLASTOMA USING 5-AMINOLEVULINIC ACID: A META-ANALYSIS. Siberian journal of oncology. 2017;16(4):54-64. (In Russ.) https://doi.org/10.21294/1814-4861-2017-16-4-54-64