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Surgery for Glioblastoma: Impact of the Combined Use of 5-Aminolevulinic Acid and Intraoperative MRI on Extent of Resection and Survival


, : Surgery for Glioblastoma: Impact of the Combined Use of 5-Aminolevulinic Acid and Intraoperative MRI on Extent of Resection and Survival. Plos One 10(6): E0131872-E0131872

There is rising evidence that in glioblastoma (GBM) surgery an increase of extent of resection (EoR) leads to an increase of patient's survival. Based on histopathological assessments tumor depiction of Gd-DTPA enhancement and 5-aminolevulinic-acid-fluorescence (5-ALA) might be synergistic for intraoperative resection control. To assess impact of additional use of 5-ALA in intraoperative MRI (iMRI) assisted surgery of GBMs on extent of resection (EoR), progression free survival (PFS) and overall survival (OS). We prospectively enrolled 33 patients with GBMs eligible for gross-total-resection(GTR) and performed a combined approach using 5-ALA and iMRI. As a control group, we performed a retrospective matched pair assessment, based on 144 patients with iMRI-assisted surgery. Matching criteria were, MGMT promotor methylation, recurrent surgery, eloquent location, tumor size and age. Only patients with an intended GTR and primary GBMs were included. We calculated Kaplan Mayer estimates to compare OS and PFS using the Log-Rank-Test. We used the T-test to compare volumetric results of EoR and the Chi-Square-Test to compare new permanent neurological deficits (nPND) and general complications between the two groups. Median follow up was 31 months. No significant differences between both groups were found concerning the matching criteria. GTR was achieved significantly more often (p <0.010) using 5-ALA&iMRI (100%) compared to iMRI alone (82%). Mean EoR was significantly (p<0.004) higher in 5-ALA&iMRI-group (99.7%) than in iMRI-alone-group (97.4%) Rate of complications did not differ significantly between groups (21% iMRI-group, 27%5-ALA&iMRI-group, p<0.518). nPND were found in 6% in both groups. Median PFS (6 mo resp.; p<0.309) and median OS (iMRI:17 mo; 5-ALA&iMRI-group: 18 mo; p<0.708)) were not significantly different between both groups. We found a significant increase of EoR when combining 5-ALA&iMRI compared to use of iMRI alone. Maximizing EoR did not lead to an increase of complications or neurological deficits if used with neurophysiological monitoring in eloquent lesions. No final conclusion can be drawn whether a further increase of EoR benefits patient's progression free survival and overall survival.

US$19.90

PMID: 26115409

DOI: 10.1371/journal.pone.0131872


Other references

Macari, M.; Machado, C.R.; Carregal, R.D.; Donini, C.A., 1976: Effects of oxytocin on semen characters in rabbits. New Zealand White rabbits were injected with 88, 133, 200, 350 or 650 IU of oxytocin immediately prior to being ejaculated. Compared with untreated controls, semen from rabbits injected with 88 IU oxytocin showed a significant reduction in ejacula...

Wolvekamp, M.C.; Heineman, E.; Taylor, R.G.; Fuller, P.J., 1996: Towards understanding the process of intestinal adaptation. When bowel is lost due to disease or surgery, the residual bowel increases its functional capacity in order to compensate for the loss of absorptive capacity. The success and extent of this adaptive process is critical to recovery. This article re...

Hung, W.L.; Wang, Y.; Chitturi, J.; Zhen, M., 2014: A Caenorhabditis elegans developmental decision requires insulin signaling-mediated neuron-intestine communication. Adverse environmental conditions trigger C. elegans larvae to activate an alternative developmental program, termed dauer diapause, which renders them stress resistant. High-level insulin signaling prevents constitutive dauer formation. However, i...

Jayaswal, V.; Ababneh, F.; Jermiin, L.S.; Robinson, J., 2012: Reducing model complexity of the general Markov model of evolution. The selection of an optimal model for data analysis is an important component of model-based molecular phylogenetic studies. Owing to the large number of Markov models that can be used for data analysis, model selection is a combinatorial problem...

Yang, L.; Huang, Y.; Wang, H.Qing.; Chen, Z-Yu., 2003: Isomeric distribution of conjugated linoleic acids (CLA) in the tissues of layer hens fed a CLA diet. The isomeric distribution of conjugated linoleic acids (CLA) in the tissue lipids of hens in relation to that in the diet was examined. Silver-ion high-performance liquid chromatography was used to quantify individual CLA isomers in total tissue l...

Lahousen M.; Stettner H.; Pickel H.; Urdl W.; Puerstner P., 1987: The predictive value of a combination of tumor markers in monitoring patients with ovarian cancer. To evaluate the predictive value of the serial determination of various tumor markers, we measured carcinoembryonic antigen, ferritin, cancer antigen 125, and tissue polypeptide antigen in 109 patients with ovarian cancer before surgery, during po...

Daumerie C.H.; Ketelslegers J.M.; Gerard G.; Lambert A.E., 1987: Glucose tolerance and its evolution in a caucasian subpopulation at risk. Diabetologia 30(7): 511A

Harris A.; Coleman L., 1988: Cultured epithelial cells derived from human fetal pancreas as a model for the study of cystic fibrosis further analyses on the origins and nature of the cell types. The establishment of a tissue-culture system for epithelial cells derived from human foetal pancreas has recently been reported. Further analyses have now been made on these cells in vitro, together with parallel investigation of the distribution...

D.G.eldre, Y.; Avesani, Véronique.; Berhin, C.; Delmée, M.; Glupczynski, Y., 2003: Evaluation of Oxoid combination discs for detection of extended-spectrum beta-lactamases. Objectives: We evaluated the reliability of cefpirome/clavulanate (CD04) compared with ceftazidime/clavulanate (CD02) and cefotaxime/clavulanate (CD03) Oxoid combination discs for the detection of extended-spectrum beta-lactamases (ESBL) in severa...

Dowling, M.A.C., 1952: The malaria eradication scheme in Mauritius. Anopheles funestus was exterminated by house-spraying with DDT. Though A. gambiae continued to breed, despite subsequent use of oil on breeding grounds, malaria is now absent from the island.