FLAIRectomy in Supramarginal Resection of Glioblastoma Correlates With Clinical Outcome and Survival Analysis: A Prospective, Single Institution, Case Series

被引:53
作者
Certo, Francesco [1 ,2 ]
Altieri, Roberto [1 ]
Maione, Massimiliano [1 ]
Schonauer, Claudio [3 ]
Sortino, Giuseppe [4 ]
Fiumano, Giuseppa [3 ]
Tirro, Elena [5 ]
Massimino, Michele [5 ]
Broggi, Giuseppe [6 ]
Vigneri, Paolo [5 ]
Magro, Gaetano [6 ]
Visocchi, Massimiliano [7 ]
Barbagallo, Giuseppe M., V [1 ,2 ]
机构
[1] Univ Catania, Policlin G Rodolico San Marco Univ Hosp, Neurol Surg, Dept Med & Surg Sci & Adv Technol GF Ingrassia, Catania, Italy
[2] Univ Catania, Interdisciplinary Res Ctr Brain Tumors Diag & Tre, Catania, Italy
[3] Santa Maria Grazie Hosp ASLNa2Nord, Dept Neurol Surg, Via Domitiana, Naples, Italy
[4] Univ Hosp Policlin Vittorio Emanuele, Dept Radiodiagnost & Oncol Radiotherapy, Via S Sofia, Catania, Italy
[5] Univ Hosp Policlin Vittorio Emanuele, Ctr Expt Oncol & Hematol, Dept Clin & Expt Med, Via S Sofia, Catania, Italy
[6] Univ Catania, Policlin G Rodol San Marco Univ Hosp, Anat Pathol, Dept Med & Surg Sci & Adv Technol GF Ingrassia, Catania, Italy
[7] Catholic Univ, Inst Neurosurg, Via Pineta Sacchetn, Rome, Italy
关键词
5-ALA; Extent of resection; FLAIR; FLAIRectomy; Glioblastoma; i-CT; Survival; Neuronavigation; FLUORESCENCE-GUIDED SURGERY; GAMMA-KNIFE RADIOSURGERY; 5-AMINOLEVULINIC ACID; PHASE-III; RADIOTHERAPY; HYPERINTENSITY; TEMOZOLOMIDE; RECOVERY; GLIOMAS; IMPACT;
D O I
10.1093/ons/opaa293
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Extent of tumor resection (EOTR) in glioblastoma surgery plays an important role in improving survival. OBJECTIVE: To analyze the efficacy, safety and reliability of fluid-attenuated inversion-recovery (FLAIR) magnetic resonance (MR) images used to guide glioblastoma resection (FLAIRectomy) and to volumetrically measure postoperative EOTR, which was correlated with clinical outcome and survival. METHODS: A total of 68 glioblastoma patients (29 males, mean age 65.8) were prospectively enrolled. Hyperintense areas on FLAIR images, surrounding gadolinium-enhancing tissue on T1-weighted MR images, were screened for signal changes suggesting tumor infiltration and evaluated for supramaximal resection. The surgical protocol included 5-aminolevulinic acid (5-ALA) fluorescence, neuromonitoring, and intraoperative imaging tools. 5-ALA fluorescence intensity was analyzed and matched with the different sites on navigated MR, both on postcontrast T1-weighted and FLAIR images. Volumetric evaluation of EOTR on T1-weighted and FLAIR sequences was compared. RESULTS: FLAIR MR volumetric evaluation documented larger tumor volume than that assessed on contrast-enhancing T1 MR (72.6 vs 54.9 cc); residual tumor was seen in 43 patients; postcontrast T1MR volumetric analysis showed complete resection in 64 cases. O6-methylguanine-DNA methyltransferase promoter was methylated in 8/68 (11.7%) cases; wild type Isocytrate Dehydrogenase-1 (IDH-1) was found in 66/68 patients. Progression free survival and overall survival (PFS and OS) were 17.43 and 25.11 mo, respectively. Multiple regression analysis showed a significant correlation between EOTR based on FLAIR, PFS (R-2 = 0.46), and OS (R-2 = 0.68). CONCLUSION: EOTR based on FLAIR and 5-ALA fluorescence is feasible. Safety of resection relies on the use of neuromonitoring and intraoperative multimodal imaging tools. FLAIR-based EOTR appears to be a stronger survival predictor compared to gadolinium-enhancing, T1-based resection.
引用
收藏
页码:151 / 163
页数:13
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