Sung Kwon Kim1, Seung Hong Choi1, Yong Hwy Kim1, Chul-Kee Park1. 1. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea (S.K.K., Y.H.K., C.-K.P.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (S.H.C.).
Abstract
BACKGROUND: To evaluate the clinical impact of fluorescence-guided surgery (FGS) in glioblastoma, we analyzed the clinical data of 80 consecutive patients operated on by a single surgeon with or without 5-aminolevulinic acid (5-ALA). METHODS: We compared 3-dimensional volumetric extent of resection and clinical outcomes between 40 consecutive patients undergoing resection using a white-light (WL) microscope and 40 subsequent consecutive patients undergoing resection using FGS with 5ALA. RESULTS: By introducing FGS, there was a significant difference in the mean volumetric extent of the resection rate of T1-enhancing lesions (84.7% in the white-light group and 97.0% in the 5-ALA group, P = .002). The complete resection rate was improved from 43% to 80%, and the proportion of resections that were <80% was reduced from 26% to 4% by FGS. The median progression-free survival was significantly better in the 5-ALA group (18.0 months vs. 6.0 months; P = .001). Although the immediate postoperative functional status was slightly worse in the 5-ALA group, this trend had reversed itself by 3 months postoperatively. CONCLUSIONS: The present study adds practical evidence of the clinical impact of 5-ALA FGS on glioblastomas from the surgeon's standpoint.
BACKGROUND: To evaluate the clinical impact of fluorescence-guided surgery (FGS) in glioblastoma, we analyzed the clinical data of 80 consecutive patients operated on by a single surgeon with or without 5-aminolevulinic acid (5-ALA). METHODS: We compared 3-dimensional volumetric extent of resection and clinical outcomes between 40 consecutive patients undergoing resection using a white-light (WL) microscope and 40 subsequent consecutive patients undergoing resection using FGS with 5ALA. RESULTS: By introducing FGS, there was a significant difference in the mean volumetric extent of the resection rate of T1-enhancing lesions (84.7% in the white-light group and 97.0% in the 5-ALA group, P = .002). The complete resection rate was improved from 43% to 80%, and the proportion of resections that were <80% was reduced from 26% to 4% by FGS. The median progression-free survival was significantly better in the 5-ALA group (18.0 months vs. 6.0 months; P = .001). Although the immediate postoperative functional status was slightly worse in the 5-ALA group, this trend had reversed itself by 3 months postoperatively. CONCLUSIONS: The present study adds practical evidence of the clinical impact of 5-ALA FGS on glioblastomas from the surgeon's standpoint.
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