Surgery guided by 5-aminolevulinic fluorescence in glioblastoma: volumetric analysis of extent of resection in single-center experience

被引:181
作者
Diez Valle, Ricardo [1 ]
Tejada Solis, Sonia [1 ]
Idoate Gastearena, Miguel Angel [2 ]
Garcia de Eulate, Reyes [3 ]
Dominguez Echavarri, Pablo [3 ]
Aristu Mendiroz, Javier [4 ]
机构
[1] Univ Navarra Clin, Dept Neurocirugia, Navarra 31008, Spain
[2] Univ Navarra Clin, Dept Anat Patol, Navarra 31008, Spain
[3] Univ Navarra Clin, Dept Radiol, Navarra 31008, Spain
[4] Univ Navarra Clin, Dept Oncol, Navarra 31008, Spain
关键词
Glioblastoma; Surgery; 5-aminolevulinic; Volumetric MRI; Gross total resection; MALIGNANT GLIOMAS; ADJUVANT TEMOZOLOMIDE; PHASE-III; SURVIVAL; MULTIFORME; ACID; RADIOTHERAPY; CONCOMITANT; SODIUM; IMPACT;
D O I
10.1007/s11060-010-0296-4
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
We analyzed the efficacy and applicability of surgery guided by 5-aminolevulinic acid (ALA) fluorescence in consecutive patients with glioblastoma multiforme (GBM). Thirty-six patients with GBM were operated on using ALA fluorescence. Resections were performed using the fluorescent light to assess the right plane of dissection. In each case, biopsies with different fluorescent quality were taken from the tumor center, from the edges, and from the surrounding tissue. These samples were analyzed separately with hematoxylin-eosin examination and immunostaining against Ki67. Tumor volume was quantified with pre- and postoperative volumetric magnetic resonance imaging. Strong fluorescence identified solid tumor with 100% positive predictive value. Invaded tissue beyond the solid tumor mass was identified by vague fluorescence with 97% positive predictive value and 66% negative predictive value, measured against hematoxylin-eosin examination. All the contrast-enhancing volume was resected in 83.3% of the patients, all patients had resection over 98% of the volume and mean volume resected was 99.8%. One month after surgery there was no mortality, and new or increased neurological morbidity was 8.2%. The fluorescence induced by 5-aminolevulinic can help to achieve near total resection of enhancing tumor volume in most surgical cases of GBM. It is possible during surgery to obtain separate samples of the infiltrating cells from the tumor border.
引用
收藏
页码:105 / 113
页数:9
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