Fluorescence-Guided versus Conventional Surgical Resection of High Grade Glioma: A Single-Centre, 7-Year, Comparative Effectiveness Study
- Author:
Wei Ping Ng
;
Boon Seng Liew
;
Azmin Kass Rosman
- Publication Type:Journal Article
- Keywords:
high grade glioma, fluorescence guided surgery, conventional surgery, Karnofsky performance
- From:Malaysian Journal of Medical Sciences
2017;24(2):78-86
- CountryMalaysia
- Language:English
-
Abstract:
Background: High grade gliomas (HGGs) are locally invasive brain tumours that carry a
dismal prognosis. Although complete resection increases median survival, the difficulty in reliably
demonstrating the tumour border intraoperatively is a norm. The Department of Neurosurgery,
Hospital Sungai Buloh is the first public hospital in Malaysia to overcome this problem by
adopting fluorescence-guided (FG) surgery using 5-aminolevulinic acid (5-ALA).
Methods: A total of 74 patients with histologically proven HGGs treated between January
2008 and December 2014, who fulfilled the inclusion criteria, were enrolled. Kaplan-Meier
survival estimates and Cox proportional hazard regression were used.
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.
- Full text:P020170508576097281919.pdf
