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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Endoscope-enhanced 5-ALA-fluorescence-guided microsurgery increases survival in patients with glioblastoma

Endoskopisch-assistierte 5-ALA-fluoreszenzgestützte Resektion erhöht das Überleben in Patienten mit Glioblastom

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  • presenting/speaker Christoph Bettag - Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
  • Bawarjan Schatlo - Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
  • Alexandra Sachkova - Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland; Universitätsmedizin Göttingen, Anästhesie, Göttingen, Deutschland
  • Hans-Christoph Bock - Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
  • Daniel Behme - Universitätsmedizin Göttingen, Neuroradiologie, Göttingen, Deutschland; Universitätsklinikum Magdeburg, Neuroradiologie, Magdeburg, Deutschland
  • Christian von der Brelie - Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV127

doi: 10.3205/22dgnc127, urn:nbn:de:0183-22dgnc1275

Published: May 25, 2022

© 2022 Bettag et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Extent of resection predicts progression free survival (PFS) and may impact overall survival (OS) in patients with glioblastoma. We recently demonstrated that 5-aminolevulinic acid-fluorescence-enhanced endoscopic surgery increased the rate of gross total resection as well as the extent of resection. However, it is hitherto unknown whether fluorescence-enhanced endoscopic resection affects survival.

Methods: We conducted a retrospective single-center analysis of a series of patients who underwent surgery for non-eloquently located glioblastoma between 2011 and 2018. All patients underwent fluorescence-guided microscopic or fluorescence-guided combined microscopic and endoscopic resection. PFS, OS, extent of resection, as well as clinical and demographic parameters, adjuvant treatment modalities and molecular characteristics, were compared between microscope-only vs. endoscope-assisted microsurgical resection.

Results: Out of 114 patients, 73 (65%) were male, and 57 (50%) were older than 65 years. Twenty patients (18%) were operated on using additional endoscopic assistance. Both cohorts were equally distributed in terms of age, performance status, lesion location, adjuvant treatment modalities and molecular status. Gross total resection was achieved in all endoscopy-assisted patients compared to about three-quarters of microscope-only patients (100% vs. 75.9%, p=0.003). The PFS in the endoscope-assisted cohort was 19.3 months (CI95% 10.8-27.7) vs. 10.8 months (CI95% 8.2-13.4; p=0.012) in the microscope-only cohort. OS in the endoscope-assisted group was 28.9 months (CI95% 20.4-34.1) compared to 16.8 months (CI95% 14.0-20.9), in the microscope-only group (p=0.001).

Conclusion: Endoscope-assisted fluorescence-guided resection of glioblastoma appears to substantially enhance gross total resection, PFS and OS. The strong effect size observed herein is contrasted by the limitations in the study design. Therefore, prospective validation is required before we can generalize our findings.