The role of 5-aminolevulinic acid in enhancing surgery for high-grade glioma, its current boundaries, and future perspectives

A systematic review

Seyed Alireza Mansouri, Sheila Mansouri, Laureen D. Hachem, George Klironomos, Michael A. Vogelbaum, Mark Bernstein, Gelareh Zadeh

Research output: Contribution to journalReview article

17 Citations (Scopus)

Abstract

5-Aminolevulinic acid (5-ALA) has been approved as an intraoperative adjunct in glioma surgery in Europe, but not North America. A systematic review was conducted to assess the evidence regarding 5-ALA as a surgical adjunct. The MEDLINE, EMBASE, and CENTRAL databases were searched, using terms relevant to “5-ALA” and “high-grade gliomas.” Included studies were based on adults aged ≥18 years who underwent surgical resection/biopsy. No language or date limitations were used. Forty-three studies (1830 patients) were identified. Thirty-six were coordinated by European countries, 2 were in the United States, and none were in Canada. One was randomized, 28 were prospective, and 14 were retrospective. Twenty-six studies assessed the utility of 5-ALA as a diagnostic tool, 24 assessed its influence on the extent of resection (EOR), 9 assessed survival, and 22 reported adverse events. 5-ALA had high sensitivity and positive predictive value, whereas its specificity increased with additional adjuncts. The EOR increased with 5-ALA, but only progression-free survival was significantly influenced. Reporting of adverse events was not systematic. The use of 5-ALA improved tumor visualization and thus enabled a greater EOR and perhaps increased survival. However, additional adjuncts may be necessary for maximizing the specificity of resection and patient safety. Additional parameters, such as patient quality of life and health economic analyses, would be informative. Thus, additional systematic collection of prospective evidence may be necessary for the global incorporation of this potentially valuable surgical adjunct into routine practice. Cancer 2016;122:2469–78.

Original languageEnglish (US)
Pages (from-to)2469-2478
Number of pages10
JournalCancer
Volume122
Issue number16
DOIs
StatePublished - Aug 15 2016

Fingerprint

Aminolevulinic Acid
Glioma
Survival
Patient Safety
North America
MEDLINE
Disease-Free Survival
Canada
Neoplasms
Language
Economics
Quality of Life
Databases
Biopsy
Health

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Mansouri, Seyed Alireza ; Mansouri, Sheila ; Hachem, Laureen D. ; Klironomos, George ; Vogelbaum, Michael A. ; Bernstein, Mark ; Zadeh, Gelareh. / The role of 5-aminolevulinic acid in enhancing surgery for high-grade glioma, its current boundaries, and future perspectives : A systematic review. In: Cancer. 2016 ; Vol. 122, No. 16. pp. 2469-2478.
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The role of 5-aminolevulinic acid in enhancing surgery for high-grade glioma, its current boundaries, and future perspectives : A systematic review. / Mansouri, Seyed Alireza; Mansouri, Sheila; Hachem, Laureen D.; Klironomos, George; Vogelbaum, Michael A.; Bernstein, Mark; Zadeh, Gelareh.

In: Cancer, Vol. 122, No. 16, 15.08.2016, p. 2469-2478.

Research output: Contribution to journalReview article

TY - JOUR

T1 - The role of 5-aminolevulinic acid in enhancing surgery for high-grade glioma, its current boundaries, and future perspectives

T2 - A systematic review

AU - Mansouri, Seyed Alireza

AU - Mansouri, Sheila

AU - Hachem, Laureen D.

AU - Klironomos, George

AU - Vogelbaum, Michael A.

AU - Bernstein, Mark

AU - Zadeh, Gelareh

PY - 2016/8/15

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N2 - 5-Aminolevulinic acid (5-ALA) has been approved as an intraoperative adjunct in glioma surgery in Europe, but not North America. A systematic review was conducted to assess the evidence regarding 5-ALA as a surgical adjunct. The MEDLINE, EMBASE, and CENTRAL databases were searched, using terms relevant to “5-ALA” and “high-grade gliomas.” Included studies were based on adults aged ≥18 years who underwent surgical resection/biopsy. No language or date limitations were used. Forty-three studies (1830 patients) were identified. Thirty-six were coordinated by European countries, 2 were in the United States, and none were in Canada. One was randomized, 28 were prospective, and 14 were retrospective. Twenty-six studies assessed the utility of 5-ALA as a diagnostic tool, 24 assessed its influence on the extent of resection (EOR), 9 assessed survival, and 22 reported adverse events. 5-ALA had high sensitivity and positive predictive value, whereas its specificity increased with additional adjuncts. The EOR increased with 5-ALA, but only progression-free survival was significantly influenced. Reporting of adverse events was not systematic. The use of 5-ALA improved tumor visualization and thus enabled a greater EOR and perhaps increased survival. However, additional adjuncts may be necessary for maximizing the specificity of resection and patient safety. Additional parameters, such as patient quality of life and health economic analyses, would be informative. Thus, additional systematic collection of prospective evidence may be necessary for the global incorporation of this potentially valuable surgical adjunct into routine practice. Cancer 2016;122:2469–78.

AB - 5-Aminolevulinic acid (5-ALA) has been approved as an intraoperative adjunct in glioma surgery in Europe, but not North America. A systematic review was conducted to assess the evidence regarding 5-ALA as a surgical adjunct. The MEDLINE, EMBASE, and CENTRAL databases were searched, using terms relevant to “5-ALA” and “high-grade gliomas.” Included studies were based on adults aged ≥18 years who underwent surgical resection/biopsy. No language or date limitations were used. Forty-three studies (1830 patients) were identified. Thirty-six were coordinated by European countries, 2 were in the United States, and none were in Canada. One was randomized, 28 were prospective, and 14 were retrospective. Twenty-six studies assessed the utility of 5-ALA as a diagnostic tool, 24 assessed its influence on the extent of resection (EOR), 9 assessed survival, and 22 reported adverse events. 5-ALA had high sensitivity and positive predictive value, whereas its specificity increased with additional adjuncts. The EOR increased with 5-ALA, but only progression-free survival was significantly influenced. Reporting of adverse events was not systematic. The use of 5-ALA improved tumor visualization and thus enabled a greater EOR and perhaps increased survival. However, additional adjuncts may be necessary for maximizing the specificity of resection and patient safety. Additional parameters, such as patient quality of life and health economic analyses, would be informative. Thus, additional systematic collection of prospective evidence may be necessary for the global incorporation of this potentially valuable surgical adjunct into routine practice. Cancer 2016;122:2469–78.

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U2 - 10.1002/cncr.30088

DO - 10.1002/cncr.30088

M3 - Review article

VL - 122

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