Surgery of high-grade gliomas guided by fluorescence: A retrospective study of 22 patients.
I know it seems obvious, but this study shows that removing more tumor helps people live longer. The difference between a total resection and a sub total resection is 8 months in overall survival: 12 months vs 20 months. This is with the simple addition of a dye that lets surgeons better visualize where the tumor is. This dye (Gliolan) is approved in Europe but the FDA in the USA is dragging it's feet in getting it approved for us.
Posted on: 01/27/2013
Neurochirurgie. 2013 Jan 11. pii: S0028-3770(12)00277-9. doi: 10.1016/j.neuchi.2012.07.002. [Epub ahead of print]
[Surgery of high-grade gliomas guided by fluorescence: A retrospective study of 22 patients.]
[Article in French]
Jacquesson T, Ducray F, Maucort-Boulch D, Armoiry X, Louis-Tisserand G, Mbaye M, Pelissou-Guyotat I, Guyotat J.
Service de neurochirurgie D, hôpital neurologique Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron cedex, France. Electronic address: email@example.com.
BACKGROUND AND PURPOSE:
Optimal surgical resection improves the prognosis of glioblastomas. However, this goal is far from being achieved due to its invasive nature. Several studies have already shown the efficacy of fluorescence-guided surgery, in improving the quality of resection of glioblastoma. We report herein our experience through a retrospective serie and describe the principles, limitations and advantages of this technique.
Between 2006 and 2009, 22 patients underwent resection of a glioblastoma guided by fluorescence. Following operations, all patients underwent sequential clinical examination and radiological monitoring using multimodal MRI. The extent of resection was assessed by the surgeon during the procedure and by the radiologist on MRI. The curves of progression-free clinical survival (SSP) and overall survival (SG) were analyzed. The prognostic value of the extent of resection was studied.
We obtained 68.2% of complete resection according to the absence of residual fluorescence as assessed by the surgeon, and 75% according to the absence of residual tumor on early MRI. The median SSP was 10.75 months and the median SG was 17 months. Complete tumoral resection confirmed by loss of fluorescence significatively increases the median SSP of 6.7 months to 12.9 months (p=0.001559) and the median SG of 12.3 months to 20.9 months (p=0.000559). After 1 year, 81.8% of patients were still alive.
Our study confirms the use of fluorescence as an effective method to allow optimal resection of glioblastoma. In addition to neuronavigation, surgical experience, vision and proprioception, fluorescence contributes to achieve a complete tumor resection.
Copyright © 2012 Elsevier Masson SAS. All rights reserved.
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