Fluorescein-guided resection of newly diagnosed high-grade glioma: Impact on extent of resection and outcome
| Autor: | Karl-Michael Schebesch, Julius Höhne, Katharina Rosengarth, Ekaterina Noeva, Nils Ole Schmidt, Martin Proescholdt |
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| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | Brain and Spine, Vol 2, Iss , Pp 101690- (2022) |
| Druh dokumentu: | article |
| ISSN: | 2772-5294 31416594 |
| DOI: | 10.1016/j.bas.2022.101690 |
| Popis: | Introduction: Maximal resection of high-grade glioma (HGG) improves progression–free survival (PFS) and overall survival (OS). Fluorescein sodium (FL) in combination with the YELLOW 560 nm filter (Carl Zeiss Meditec, Germany) is a safe and feasible method of visualizing residual tumor tissue during brain tumor resection. Research question: We hypothesized that use of FL positively influenced the volumetric extent of resection (EOR), PFS, and OS in patients undergoing resection of a newly diagnosed HGG. Materials and method: Using a prospective HGG registry, we identified 347 patients (median age 62.4 years; 141 women) with preoperative high-quality magnetic resonance images for volumetric analysis. Resection was performed under white light in n = 151 (43.5%, white-light group) and under FL-guidance in n = 196 (56.5%, FL group). Sex, age, presurgical Karnofsky Performance Index (KPI), O6-Methylguanin-DNA-Methyltransferase-Gene (MGMT) status, and adjuvant treatment modalities were well balanced between the groups. Volumetric analysis was performed by quantifying pre- and postoperative tumor volume based on gadolinium-enhanced T1 sequences in a blinded fashion. Results: In the FL group, postoperative tumor volume was significantly smaller (p = 0.003); accordingly, quantitative EOR was significantly larger (p = 0.003). Significantly more complete resections were achieved in the FL group than in the white-light group (p = 0.003). The FL group showed significantly longer PFS (p = 0.020) and OS (p = 0.015, log rank testing). Multivariate Cox regression modelling showed age, presurgical KPI, MGMT status, and FL-guided resection to be independent prognostic factors for survival. Discussion and conclusion: Compared to white-light resection, FL-guided resection of newly diagnosed HGG significantly improved EOR and prolonged OS. |
| Databáze: | Directory of Open Access Journals |
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