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5-ALA Fluorescence Image Guided Resection of Glioblastoma Multiforme: A Meta-Analysis of the Literature
1Neurological Surgery, High Tech Neuro & Micro Surgery, Edinburgh EH3 8JB, UK. professer.ms.eljamel@gmail.com.
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.
Insights
5-aminolevulinic acid (5-ALA) fluorescence image-guided resection significantly improves gross total resection rates and time to tumor progression in glioblastoma multiforme (GBM) patients. This technique offers high sensitivity and specificity for enhanced local control.
Area of Science:
- Neurosurgery
- Oncology
- Medical Imaging
Background:
- Glioblastoma multiforme (GBM) is a highly aggressive brain tumor with poor prognosis.
- Local disease progression is a primary cause of mortality in GBM patients.
- Fluorescence image-guided resection (FIGR) is a promising approach to improve surgical outcomes.
Purpose of the Study:
- To perform a meta-analysis on the efficacy of 5-aminolevulinic acid (5-ALA) induced FIGR in GBM.
- To evaluate the impact of 5-ALA-FIGR on gross total resection (GTR) rates.
- To assess the effect of 5-ALA-FIGR on tumor progression and overall survival.
Main Methods:
- Systematic literature review of 503 publications.
- Inclusion of 20 studies with 565 GBM patients treated with 5-ALA-FIGR.
- Analysis of 800 histological samples for sensitivity and specificity of 5-ALA-FIGR.
Main Results:
- Mean GTR rate of 75.4% (p<0.001).
- Mean time to tumor progression (TTP) of 8.1 months (p<0.001).
- Mean overall survival gain of 6.2 months (p<0.001).
- High diagnostic accuracy: sensitivity 82.6% (p<0.001), specificity 88.9% (p<0.001).
Conclusions:
- 5-ALA-FIGR is a highly sensitive and specific method for GBM resection.
- 5-ALA-FIGR significantly improves GTR rates in GBM patients.
- This technique enhances local tumor control, leading to improved TTP.
