• Neuro-oncology · Dec 2015

    Outcomes after combined use of intraoperative MRI and 5-aminolevulinic acid in high-grade glioma surgery.

    • Bawarjan Schatlo, Javier Fandino, Nicolas R Smoll, Oliver Wetzel, Luca Remonda, Serge Marbacher, Wolfgang Perrig, Hans Landolt, and Ali-Reza Fathi.
    • Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.).
    • Neuro-oncology. 2015 Dec 1; 17 (12): 1560-7.

    BackgroundPrevious studies have shown the individual benefits of 5-aminolevulinic acid (5-ALA) and intraoperative (i)MRI in enhancing survival for patients with high-grade glioma. In this retrospective study, we compare rates of progression-free and overall survival between patients who underwent surgical resection with the combination of 5-ALA and iMRI and a control group without iMRI.MethodsIn 200 consecutive patients with high-grade gliomas, we recorded age, sex, World Health Organization tumor grade, and pre- and postoperative Karnofsky performance status (good ≥80 and poor <80). A 0.15-Tesla magnet was used for iMRI; all patients operated on with iMRI received 5-ALA. Overall and progression-free survival rates were compared using multivariable regression analysis.ResultsMedian overall survival was 13.8 months in the non-iMRI group and 17.9 months in the iMRI group (P = .043). However, on identifying confounding variables (ie, KPS and resection status) in this univariate analysis, we then adjusted for these confounders in multivariate analysis and eliminated this distinction in overall survival (hazard ratio: 1.23, P = .34, 95% CI: 0.81, 1.86). Although 5-ALA enhanced the achievement of gross total resection (odds ratio: 3.19, P = .01, 95% CI: 1.28, 7.93), it offered no effect on overall or progression-free survival when adjusted for resection status.ConclusionsGross 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.© The Author(s) 2015. Published by Oxford University Press on behalf of the Society for Neuro-Oncology.

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