Artikel
Outcomes after combined use of intraoperative MRI and 5-aminolaevulinic acid in high-grade glioma surgery
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Autoren
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Bawarjan Schatlo
- Klinik für Neurochirurgie, Kantonsspital Aarau, Aarau, Schweiz; Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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Javier Fandino
- Klinik für Neurochirurgie, Kantonsspital Aarau, Aarau, Schweiz
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Nicolas R. Smoll
- Department of Surgery, Frankston Hospital, Frankston, Australia
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Oliver Wetzel
- Klinik für Neurochirurgie, Kantonsspital Aarau, Aarau, Schweiz
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Luca Remonda
- Klinik für Neuroradiologie, Kantonsspital, Aarau, Schweiz
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Veit Rohde
- Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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Serge Marbacher
- Klinik für Neurochirurgie, Kantonsspital Aarau, Aarau, Schweiz
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Hans Landolt
- Klinik für Neurochirurgie, Kantonsspital Aarau, Aarau, Schweiz
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Ali-Reza Fathi
- Klinik für Neurochirurgie, Kantonsspital Aarau, Aarau, Schweiz
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: Previous studies have shown that both 5-aminolaevulinic acid (5-ALA)-flourescence guided resection (FGR) and intraoperative magnetic resonance imaging (iMRI) enhance the amount of resection and, thereby, improve survival in patients with high-grade glioma. One might therefore assume that the combination of FGR and iMRI further increases survival rates. In this retrospective study, we compare rates of progression-free and overall survival between patients undergoing surgical resection with the combination of FGR and iMRI and patients without iMRI.
Method: In 200 consecutive patients with high-grade gliomas, we recorded World Health Organization (WHO) grade of the tumor, and pre- and postoperative Karnofsky performance status (KPS) (good ≥80 and poor <80). A 0.15 Tesla magnet was used for iMRI; all patients operated with iMRI received 5-ALA. Overall and progression-free survival rates were compared using multivariable regression analysis.
Results: Thirty-two percent of patients (n=63) were female. Mean age was 57 ± 12years. A total of 387.5 years of follow-up time (4,650 months) were recorded. 166 patients had a WHO Grade IV tumor (83%), the remaining 34 had a WHO grade III tumor. Median overall survival (OS) was 13.8 months in the non-iMRI group (n=145) and 17.9 months in the iMRI plus FGR group (n=55; p=0.043). However, on identifying confounding variables (i.e. KPS and resection status) in this univariate analysis, we then adjusted for these cofounders in multivariate analysis and eliminated this distinction in overall survival (HR 1.23, p=0.34, 95%CI 0.81, 1.86). Although 5-ALA fluorescence enhanced the rate of gross total resection (OR 3.19, p=0.01) (5%CI 1.28, 7.93), the combined effect with iMRI on overall or progression-free survival when adjusted for resection status remained below the threshold of significance.
Conclusions: Gross total resection is the key surgical variable that influences progression and survival in patients with high-grade glioma and more likely when surgical adjuncts, such as iMRI in combination with 5-ALA, are used to enhance resection.
