Fluorescence-Guided versus Conventional Surgical Resection of High Grade Glioma: A Single-Centre, 7-Year, Comparative Effectiveness Study

Abstract

To cite this article: Ng WP, Liew BS, Idris Z, Rosman AK. Fluorescence-guided versus conventional surgical resection of high grade glioma: a single-centre, 7-Year, comparative effectiveness study. Results: Significant longer survival time (months) was observed in the FG group compared with the conventional group (12 months versus 8 months, P < 0.020). Even without adjuvant therapy, HGG patients from FG group survived longer than those from the conventional group (8 months versus 3 months, P = 0.006). No significant differences were seen in postoperative Karnofsky performance scale (KPS) between the groups at 6 weeks and 6 months after surgery compared to pre-operative KPS. Cox proportional hazard regression identified four independent predictors of survival: KPS > 80 (P = 0.010), histology (P < 0.001), surgical method (P < 0.001) and adjuvant therapy (P < 0.001).Conclusion: This study showed a significant clinical benefit for HGG patients in terms of overall survival using FG surgery as it did not result in worsening of post-operative function outcome when compared with the conventional surgical method. We advocate a further multicentered, randomised controlled trial to support these findings before FG surgery can be implemented as a standard surgical adjunct in local practice for the benefit of HGG patients.

Survival Outcomes Among Patients With High-Grade Glioma Treated With 5-Aminolevulinic Acid–Guided Surgery: A Systematic Review and Meta-Analysis

“…Of the 23 studies, 9 reported a mean OS period in months ranging from 10 to 22 months (5, 25, 26, 31, 34, 44–47). One of the studies, by Stummer et al (31), stratified the survival analysis by age (55 years of age and younger vs. older than 55 years).…”

“…The meta-analysis in the group of patients with primary HGG who underwent 5-ALA–guided resection showed a mean OS of 16.3 months (95% CI, 14.1–18.5 months; P < 0.001) (Figure 5). Five studies (seven distinct 5-ALA groups) were available for comparison of OS (measured as a mean survival difference) between 5-ALA vs. control groups (25, 31, 34, 46, 47). No significant heterogeneity was noted across these groups ( I 2 = 0%; P = 0.47); hence, we used a fixed-effects model.…”

Augmentation of 5-Aminolevulinic Acid Treatment of Glioblastoma by Adding Ciprofloxacin, Deferiprone, 5-Fluorouracil and Febuxostat: The CAALA Regimen

“…Intraoperative PpIX fluorescence-guided resection gives longer progression-free survival. Two studies from 2017 showed preferential overall survival with 5-ALA guided resection [14,15].…”

“…5-ALA use in glioma surgery was reviewed twice in 2017 [15,29]. Four papers published in 2018 recounted the various factors active in determining the degree of GB cells’ PpIX content [2,3,4,5].…”

Augmentation of 5-aminolevulinic Acid Treatment of Glioblastoma by Adding Ciprofloxacin, Deferiprone, 5-fluorouracil and Febuxostat: The CAALA Regimen

“…5-ALA use in glioma surgery was reviewed twice in 2017 [15,29]. Four papers published in 2018 recounted the various factors active in determining degree of GB cells' PpIX content [2][3][4][5].…”