Departement of Neurosurgery, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium.
Departement of Neurosurgery, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium; Hasselt University, Belgium.
Clin Neurol Neurosurg. 2020 Aug;195:105913. doi: 10.1016/j.clineuro.2020.105913. Epub 2020 May 16.
Nowadays, several techniques have been developed in order to guide neurosurgeons during intended maximal safe resection of high-grade gliomas (HGG). Fluorescence-guided microsurgery using 5-aminolevulinic acid (5-ALA) is one of these. A large amount of studies have been performed evaluating benefits in newly diagnosed HGG. However, little is known about the safety, accuracy and efficacy in recurrent HGG. The primary objective of this thesis is to examine the value of 5-ALA in patients with recurrent HGG concerning diagnostic accuracy, extent of resection (EOR), safety and survival compared to white-light resection. As a secondary objective, we compared these results with current literature concerning 5-ALA in newly diagnosed HGG.
We performed a systematic review and included eighteen articles obtained from MEDLINE, EMBASE, Web of Science and TRIP database. Search terms include "glioma" and "aminolevulinic acid". Additional studies were identified through checking the reference lists. This study is in conformity with the PRISMA and BMJ guidelines.
5-ALA shows similar results regarding diagnostic accuracy in recurrent HGG compared to newly diagnosed HGG, although specificity and negative predictive value seem lower. It shows complementary value in identifying tumor boundaries compared to MRI-neuronavigation. Diagnostic accuracy is not influenced by previous chemo- or radiotherapy. New neurological deficits proved to be similar and were in general mainly temporary. However, adverse events overall were more common. Therefore, indications for repeat surgery should be followed strictly. 5-ALA might increase overall survival in recurrent gliomas, but has no clear impact on progression-free survival.
5-ALA should be regarded as a useful and safe intraoperative tool in recurrent glioma surgery.
为了指导神经外科医生进行高级别胶质瘤（HGG）的最大安全切除，目前已经开发出了几种技术。使用 5-氨基酮戊酸（5-ALA）的荧光引导显微镜手术就是其中之一。已经进行了大量研究来评估其在新诊断的 HGG 中的益处。然而，对于复发性 HGG，其安全性、准确性和疗效知之甚少。本论文的主要目的是检查 5-ALA 在复发性 HGG 患者中的价值，与白光切除相比，其在诊断准确性、切除程度（EOR）、安全性和生存率方面的价值。作为次要目标，我们将这些结果与当前关于新诊断的 HGG 中 5-ALA 的文献进行了比较。
我们进行了系统评价，并从 MEDLINE、EMBASE、Web of Science 和 TRIP 数据库中获得了 18 篇文章。搜索词包括“glioma”和“aminolevulinic acid”。通过检查参考文献列表，还确定了其他研究。本研究符合 PRISMA 和 BMJ 指南。
与新诊断的 HGG 相比，5-ALA 在复发性 HGG 中的诊断准确性相似，尽管特异性和阴性预测值似乎较低。与 MRI-神经导航相比，它在识别肿瘤边界方面具有互补价值。诊断准确性不受先前化疗或放疗的影响。新的神经功能缺损相似，且通常主要是暂时的。然而，总的来说，不良事件更为常见。因此，应严格遵循再次手术的适应证。5-ALA 可能会增加复发性胶质瘤的总生存率，但对无进展生存率没有明显影响。
5-ALA 应被视为复发性胶质瘤手术中有用且安全的术中工具。
