5-ALA Fluorescence Image Guided Resection of Glioblastoma Multiforme: A Meta-Analysis of the Literature

Overview

Journal Int J Mol Sci

Publisher MDPI

Specialties Biochemistry
Chemistry
Molecular Biology

Date 2015 May 12

PMID 25961952

Citations 47

Authors

Samy Eljamel

Affiliations

Soon will be listed here.

Abstract

Background: Glioblastoma multiforme (GBM) is one of the most deadly cancers in humans. Despite recent advances in anti-cancer therapies, most patients with GBM die from local disease progression. Fluorescence image guided surgical resection (FIGR) was recently advocated to enhance local control of GBM. This is meta-analyses of 5-aminolevulinic (5-ALA) induced FIGR.

Materials: Review of the literature produced 503 potential publications; only 20 of these fulfilled the inclusion criteria of this analysis, including a total of 565 patients treated with 5-ALA-FIGR reporting on its outcomes and 800 histological samples reporting 5-ALA-FIGR sensitivity and specificity.

Results: The mean gross total resection (GTR) rate was 75.4% (95% CI: 67.4-83.5, p<0.001). The mean time to tumor progression (TTP) was 8.1 months (95% CI: 4.7-12, p<0.001). The mean overall survival gain reported was 6.2 months (95% CI: -1-13, p<0.001). The specificity was 88.9% (95% CI: 83.9-93.9, p<0.001) and the sensitivity was 82.6% (95% CI: 73.9-91.9, p<0.001).

Conclusion: 5-ALA-FIGR in GBM is highly sensitive and specific, and imparts significant benefits to patients in terms of improved GTR and TTP.

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References

Stummer W, Pichlmeier U, Meinel T, Wiestler O, Zanella F, Reulen H . Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol. 2006; 7(5):392-401. DOI: 10.1016/S1470-2045(06)70665-9. View

Slotty P, Siantidis B, Beez T, Steiger H, Sabel M . The impact of improved treatment strategies on overall survival in glioblastoma patients. Acta Neurochir (Wien). 2013; 155(6):959-63. DOI: 10.1007/s00701-013-1693-1. View

Hefti M, von Campe G, Moschopulos M, Siegner A, Looser H, Landolt H . 5-aminolevulinic acid induced protoporphyrin IX fluorescence in high-grade glioma surgery: a one-year experience at a single institutuion. Swiss Med Wkly. 2008; 138(11-12):180-5. DOI: 10.4414/smw.2008.12077. View

Zhao S, Wu J, Wang C, Liu H, Dong X, Shi C . Intraoperative fluorescence-guided resection of high-grade malignant gliomas using 5-aminolevulinic acid-induced porphyrins: a systematic review and meta-analysis of prospective studies. PLoS One. 2013; 8(5):e63682. PMC: 3665818. DOI: 10.1371/journal.pone.0063682. View

Acerbi F, Broggi M, Eoli M, Anghileri E, Cuppini L, Pollo B . Fluorescein-guided surgery for grade IV gliomas with a dedicated filter on the surgical microscope: preliminary results in 12 cases. Acta Neurochir (Wien). 2013; 155(7):1277-86. DOI: 10.1007/s00701-013-1734-9. View

Pastor J, Vega-Zelaya L, Pulido P, Garnes-Camarena O, Abreu A, Sola R . Role of intraoperative neurophysiological monitoring during fluorescence-guided resection surgery. Acta Neurochir (Wien). 2013; 155(12):2201-13. DOI: 10.1007/s00701-013-1864-0. View

Eljamel S, Petersen M, Valentine R, Buist R, Goodman C, Moseley H . Comparison of intraoperative fluorescence and MRI image guided neuronavigation in malignant brain tumours, a prospective controlled study. Photodiagnosis Photodyn Ther. 2013; 10(4):356-61. DOI: 10.1016/j.pdpdt.2013.03.006. View

Chung I, Eljamel S . Risk factors for developing oral 5-aminolevulinic acid-induced side effects in patients undergoing fluorescence guided resection. Photodiagnosis Photodyn Ther. 2013; 10(4):362-7. DOI: 10.1016/j.pdpdt.2013.03.007. View

Coburger J, Engelke J, Scheuerle A, Thal D, Hlavac M, Wirtz C . Tumor detection with 5-aminolevulinic acid fluorescence and Gd-DTPA-enhanced intraoperative MRI at the border of contrast-enhancing lesions: a prospective study based on histopathological assessment. Neurosurg Focus. 2014; 36(2):E3. DOI: 10.3171/2013.11.FOCUS13463. View

10.

Acerbi F, Broggi M, Eoli M, Anghileri E, Cavallo C, Boffano C . Is fluorescein-guided technique able to help in resection of high-grade gliomas?. Neurosurg Focus. 2014; 36(2):E5. DOI: 10.3171/2013.11.FOCUS13487. View

11.

Diez Valle R, Slof J, Galvan J, Arza C, Romariz C, Vidal C . Observational, retrospective study of the effectiveness of 5-aminolevulinic acid in malignant glioma surgery in Spain (The VISIONA study). Neurologia. 2013; 29(3):131-8. DOI: 10.1016/j.nrl.2013.05.004. View

12.

Della Puppa A, Ciccarino P, Lombardi G, Rolma G, Cecchin D, Rossetto M . 5-Aminolevulinic acid fluorescence in high grade glioma surgery: surgical outcome, intraoperative findings, and fluorescence patterns. Biomed Res Int. 2014; 2014:232561. PMC: 3997860. DOI: 10.1155/2014/232561. View

13.

Piquer J, Llacer J, Rovira V, Riesgo P, Rodriguez R, Cremades A . Fluorescence-guided surgery and biopsy in gliomas with an exoscope system. Biomed Res Int. 2014; 2014:207974. PMC: 4055357. DOI: 10.1155/2014/207974. View

14.

Zimmermann A, Ritsch-Marte M, Kostron H . mTHPC-mediated photodynamic diagnosis of malignant brain tumors. Photochem Photobiol. 2001; 74(4):611-6. DOI: 10.1562/0031-8655(2001)074<0611:MMPDOM>2.0.CO;2. View

15.

Stummer W, Novotny A, Stepp H, Goetz C, Bise K, Reulen H . Fluorescence-guided resection of glioblastoma multiforme by using 5-aminolevulinic acid-induced porphyrins: a prospective study in 52 consecutive patients. J Neurosurg. 2000; 93(6):1003-13. DOI: 10.3171/jns.2000.93.6.1003. View

16.

Su X, Huang Q, Chen H, Chen J . Fluorescence-guided resection of high-grade gliomas: a systematic review and meta-analysis. Photodiagnosis Photodyn Ther. 2014; 11(4):451-8. DOI: 10.1016/j.pdpdt.2014.08.001. View

17.

Shinoda J, Yano H, Yoshimura S, Okumura A, Kaku Y, Iwama T . Fluorescence-guided resection of glioblastoma multiforme by using high-dose fluorescein sodium. Technical note. J Neurosurg. 2003; 99(3):597-603. DOI: 10.3171/jns.2003.99.3.0597. View

18.

Eljamel M, Goodman C, Moseley H . ALA and Photofrin fluorescence-guided resection and repetitive PDT in glioblastoma multiforme: a single centre Phase III randomised controlled trial. Lasers Med Sci. 2007; 23(4):361-7. DOI: 10.1007/s10103-007-0494-2. View

19.

Kremer P, Fardanesh M, Ding R, Pritsch M, Zoubaa S, Frei E . Intraoperative fluorescence staining of malignant brain tumors using 5-aminofluorescein-labeled albumin. Neurosurgery. 2009; 64(3 Suppl):ons53-60. DOI: 10.1227/01.NEU.0000335787.17029.67. View

20.

Eljamel M . Brain photodiagnosis (PD), fluorescence guided resection (FGR) and photodynamic therapy (PDT): past, present and future. Photodiagnosis Photodyn Ther. 2009; 5(1):29-35. DOI: 10.1016/j.pdpdt.2008.01.006. View