Hermelin Brain Tumor Center, Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA.
Department of Neurosurgery, K-11, Henry Ford Hospital, Detroit, MI, 48202, USA.
J Neurooncol. 2019 Feb;141(3):507-515. doi: 10.1007/s11060-018-03061-3. Epub 2018 Dec 1.
Glioma surgery at its nascency relied predominantly on visual and tactile feedback for the removal of grossly abnormal tissue. This technique has inherent limitations in delineating infiltrative tumor from normal brain, thus limiting the ability to achieve a gross total resection consistently. Since extent of resection (EOR) is consistently correlated with measures of survival, fluorescence-guided surgery shows promise in improving our ability to treat high-grade gliomas (HGG). 5-Aminolevulinic acid (5-ALA) is a prodrug preferentially metabolized by glioma cells that allows direct, real-time visualization of pathologic tissue through fluorescence under blue light.
To report the relationship between 5-ALA and EOR in newly diagnosed HGG. To report our institutional experience including nuances of workflow.
The authors performed a systematic review of the available literature between 1998 and 2018 to isolate studies addressing the impact of fluorescence-guided surgery with 5-ALA on the EOR in newly diagnosed HGG. Search strategy was in adherence to the preferred reporting items for systematic reviews and meta-analyses methodology.
Out of 741 unique articles, eight fulfilled our strict inclusion criteria. Fluorescence-guided resection led to greater EOR in all studies, with six demonstrating statistical significance (p < 0.05). Two studies additionally demonstrated statistically significant increase in progression-free survival in the 5-ALA groups.
5-ALA has an unambiguously positive impact on improving EOR for newly diagnosed HGG. Since the nature of modern glioma surgery includes a complex arsenal of surgical adjuncts, 5-ALA is seldom examined in isolation and can be complemented by intraoperative MRI.
在神经胶质瘤手术的早期，主要依靠视觉和触觉反馈来切除明显异常的组织。这种技术在区分浸润性肿瘤与正常脑组织方面存在固有局限性，从而限制了实现大体全切除的能力。由于切除范围（EOR）与生存测量结果一致，荧光引导手术有望提高我们治疗高级别神经胶质瘤（HGG）的能力。5-氨基乙酰丙酸（5-ALA）是一种前体药物，优先被神经胶质瘤细胞代谢，通过蓝光下的荧光直接实时可视化病理组织。
报告新诊断的 HGG 中 5-ALA 与 EOR 之间的关系。报告我们机构的经验，包括工作流程的细微差别。
作者对 1998 年至 2018 年期间可用文献进行了系统回顾，以分离出研究荧光引导手术与 5-ALA 对新诊断的 HGG 的 EOR 影响的研究。搜索策略符合系统评价和荟萃分析方法的首选报告项目。
在 741 篇独特的文章中，有 8 篇严格符合我们的纳入标准。荧光引导切除在所有研究中均导致更大的 EOR，其中 6 项具有统计学意义（p<0.05）。两项研究还证明 5-ALA 组的无进展生存期有统计学意义的增加。
5-ALA 对改善新诊断的 HGG 的 EOR 具有明确的积极影响。由于现代神经胶质瘤手术的性质包括复杂的手术辅助手段，5-ALA 很少单独检查，并且可以与术中 MRI 互补。
