INTRAOPERATIVE FLUORESCENCE-GUIDED RESECTION OF HIGH-GRADE GLYOBLASTOMA USING 5-AMINOLEVULINIC ACID: A META-ANALYSIS

Abstract

Background. Glioblastoma (GBM) is a high-grade primary brain tumor characterized by resistance to modern treatment modalities. Intraoperative fluorescence-guided resection using 5-aminolevulinic acid (5-ALA) is one of the most innovative techniques to improve the local control rate in GBM surgery. Objective: to assess the diagnostic accuracy, sensitivity and specificity of 5-ALA fluorescence- guided resection (5-ALA-FGR) in patients with GBM. Material and methods. Surgical outcomes of 5-ALA-FGR in patients with GBM were studied in a meta-analysis of clinical series published from 2000 to 2017. Results. The meta-analysis included 26 studies. Gross total tumor resection was achieved in 74.8 % of patients (95 % CI: 67.4–83.5 %). The use of 5-ALA-FGR increased the disease-free survival time in patients with GBM by an average of 8.14 months (95 % CI: 4.36–12.02). The difference in the overall survival of GBM patients in favor of 5-ALA-FGR was 4.35–6.17 months (95 % CI: 0.9–13.23). The specificity and sensitivity of 5-ALA-FGR was high, being 86.6–87.5 % (95 % CI: 81.6–91.7) and 79.8–82.2 % (95 % CI: 73.5–91.07), respectively. Conclusion. The meta-analysis of 26 clinical series showed the high sensitivity and specificity of 5-ALA-FGR. Moreover, the use of 5-ALA-FGR in GBM was reported to increase the disease-free survival and the extent of surgical resection in patients with GBM.