Experience Profiling of Fluorescence-Guided Surgery I: Gliomas = Experience Profiling of Fluorescence-Guided Surgery I: Gliomas

다국어 초록 (Multilingual Abstract)

Background Numerous studies reported a usefulness of 5-aminolevulinic acid (5-ALA) fluorescence- guided surgery (FGS) in high grade gliomas. However, fluorescence patterns and intensities are variable among gliomas. In this study, we report our extensive experience with FGS in various gliomas, focusing on epidemiological data of fluorescence patterns.
Methods A total of 827 histologically proven glioma patients out of 900 brain tumor patients who had undergone FGS using 5-ALA during the period of 8.5 years between July 2010 and January 2019 were analyzed. Indications of FGS in glioma surgery are evidence for possible high-grade foci in putative gliomas in preoperative MRI.
Results Among the 827 gliomas, the number of cases corresponding to 2016 World Health Organization (WHO) grade IV, III, II, and I are 528 (58.7%), 193 (21.4%), 87 (9.7%) and 19 (2.1%), respectively. In terms of fluorescence rate, grade IV gliomas showed positive fluorescence in 95.4% of cases including strong intensity in 85.6%. Grade III gliomas showed fluorescence in about half of cases (55.0%), but 45.0% of the cases showed no fluorescence at all. Anaplastic oligodendroglioma had a higher positive rate (63.9%) than anaplastic astrocytoma (46.2%). Both grade II and I gliomas still showed positive fluorescence in about one-fourth of cases (24.1% and 26.3% respectively). Among them ependymoma and pilocytic astrocytoma were fluorescence-prone tumors.
Conclusion This epidemiological data of 5-ALA fluorescence in various grades of glioma provides a basic reference to the clinical application of FGS with 5-ALA in glioma surgery.

참고문헌 (Reference)

1 Hadjipanayis CG, "What is the surgical benefit of utilizing 5-aminolevulinic acid for fluorescence-guided surgery of malignant gliomas?" 77 : 663-673, 2015

2 Marbacher S, "Use of fluorescence to guide resection or biopsy of primary brain tumors and brain metastases" 36 : E10-, 2014

3 Jaber M, "The value of 5-aminolevulinic acid in low-grade gliomas and high-grade gliomas lacking glioblastoma imaging features: an analysis based on fluorescence, magnetic resonance imaging, 18F-fluoroethyl tyrosine positron emission tomography, and tumor molecular factors" 78 : 401-411, 2016

4 Zhang C, "The use of 5-aminolevulinic acid in resection of pediatric brain tumors: a critical review" 141 : 567-573, 2019

5 Ferraro N, "The role of 5-aminolevulinic acid in brain tumor surgery: a systematic review" 39 : 545-555, 2016

6 Stummer W, "The importance of surgical resection in malignant glioma" 22 : 645-649, 2009

7 Wolburg H, "The disturbed blood-brain barrier in human glioblastoma" 33 : 579-589, 2012

8 Teng L, "Silencing of ferrochelatase enhances 5-aminolevulinic acid-based fluorescence and photodynamic therapy efficacy" 104 : 798-807, 2011

9 Smith JS, "Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas" 26 : 1338-1345, 2008

10 Chung IW, "Risk factors for developing oral 5-aminolevulinic acid-induced side effects in patients undergoing fluorescence guided resection" 10 : 362-367, 2013

11 Valdés PA, "Quantitative fluorescence in intracranial tumor: implications for ALA-induced PpIX as an intraoperative biomarker" 115 : 11-17, 2011

12 Kim JE, "Mechanism for enhanced 5-aminolevulinic acid fluorescence in isocitrate dehydrogenase 1 mutant malignant gliomas" 6 : 20266-20277, 2015

13 Hervey-Jumper SL, "Maximizing safe resection of low- and high-grade glioma" 130 : 269-282, 2016

14 Haj-Hosseini N, "Low dose 5-aminolevulinic acid: implications in spectroscopic measurements during brain tumor surgery" 12 : 209-214, 2015

15 Jaber M, "Is visible aminolevulinic acid-induced fluorescence an independent biomarker for prognosis in histologically confirmed (World Health Organization 2016) low-grade gliomas?" 84 : 1214-1224, 2019

16 Roessler K, "Intraoperative tissue fluorescence using 5-aminolevolinic acid (5-ALA) is more sensitive than contrast MRI or amino acid positron emission tomography ((18)F-FET PET) in glioblastoma surgery" 34 : 314-317, 2012

17 McGirt MJ, "Independent association of extent of resection with survival in patients with malignant brain astrocytoma" 110 : 156-162, 2009

18 Zhao SG, "Increased expression of ABCB6enhances protoporphyrin IX accumulation and photodynamic effect in human glioma" 20 : 4379-4388, 2013

19 Stummer W, "In vitro and in vivo porphyrin accumulation by C6 glioma cells after exposure to 5-aminolevulinic acid" 45 : 160-169, 1998

20 Kim SK, "Impact of fluorescence-guided surgery on the improvement of clinical outcomes in glioblastoma patients" 1 : 81-85, 2014

21 Kim S, "Glutaminase 2 expression is associated with regional heterogeneity of 5-aminolevulinic acid fluorescence in glioblastoma" 7 : 12221-, 2017

22 GmbH M, "Gliolan(R) product information" Medac

23 Roberts DW, "Glioblastoma multiforme treatment with clinical trials for surgical resection (aminolevulinic acid)" 23 : 371-377, 2012

24 Saito K, "Genetic factors affecting intraoperative 5-aminolevulinic acid-induced fluorescence of diffuse gliomas" 51 : 142-150, 2017

25 Nishikawa R, "Fluorescence illuminates the way…" 13 : 805-, 2011

26 Ewelt C, "Finding the anaplastic focus in diffuse gliomas: the value of Gd-DTPA enhanced MRI, FET-PET, and intraoperative, ALA-derived tissue fluorescence" 113 : 541-547, 2011

27 McGirt MJ, "Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas" 63 : 700-707, 2008

28 Marko NF, "Extent of resection of glioblastoma revisited: personalized survival modeling facilitates more accurate survival prediction and supports a maximumsafe-resection approach to surgery" 32 : 774-782, 2014

29 Díez Valle R, "Established and emerging uses of 5-ALA in the brain: an overview" 141 : 487-494, 2019

30 Stupp R, "Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial" 10 : 459-466, 2009

31 Stummer W, "Counterbalancing risks and gains from extended resections in malignant glioma surgery: a supplemental analysis from the randomized 5-aminolevulinic acid glioma resection study. Clinical article" 114 : 613-623, 2011

32 Valdés PA, "Combined fluorescence and reflectance spectroscopy for in vivo quantification of cancer biomarkers in low- and high-grade glioma surgery" 16 : 116007-, 2011

33 Brown PD, "A prospective study of quality of life in adults with newly diagnosed high-grade gliomas: the impact of the extent of resection on quality of life and survival" 57 : 495-504, 2005

34 Widhalm G, "5-Aminolevulinic acid is a promising marker for detection of anaplastic foci in diffusely infiltrating gliomas with nonsignificant contrast enhancement" 116 : 1545-1552, 2010

35 Widhalm G, "5-Aminolevulinic acid induced fluorescence is a powerful intraoperative marker for precise histopathological grading of gliomas with non-significant contrast-enhancement" 8 : e76988-, 2013

36 Stepp H, "5-ALA in the management of malignant glioma" 50 : 399-419, 2018

37 Schwake M, "5-ALA fluorescence-guided surgery in pediatric brain tumorsa systematic review" 161 : 1099-1108, 2019

38 Schucht P, "5-ALA complete resections go beyond MR contrast enhancement: shift corrected volumetric analysis of the extent of resection in surgery for glioblastoma" 156 : 305-312, 2014