Background: Several studies have confirmed the impact of 5-aminolevulinic acid (5-ALA) on the extent of resection in newly diagnosed glioblastoma (GBM). However, there are controversies on the 5-ALA fluorescence status in recurrent GBM surgery, with specific reference to pseudoprogression or radionecrosis; therefore, the safety and accuracy of surgical planning in 5-ALA-assisted procedures in the recurrent context are still unclear. Materials and Methods: This is a systematic review and meta-analysis of comparative studies on the use of 5-ALA in newly diagnosed and recurrent GBM, consistently conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Data on fluorescence status and correlation between fluorescence and histological findings were collected. We performed a meta-analysis of proportions to estimate the pooled rates of each outcome. Results: Three online medical databases (PubMed, Scopus, Cochrane Library) were screened, 448 articles were evaluated, and 3 papers were finally included for data analysis. Fluorescence rate was not different between newly diagnosed and recurrent GBM [p = 0.45; odds ratio (OR): 1.23; 95% CI: 0.72–2.09; I2 = 0%], while the rate of 5-ALA fluorescence-positive areas not associated with histological findings of GBM cells was higher in recurrent GBM (p = 0.04; OR: 0.24; 95% CI: 0.06–0.91; I2 = 19%). Furthermore, there were no cases of radionecrosis in false-positive samples, while inflammation and signs of pseudoprogression were found in 81.4% of the cases. Discussion and Conclusions: Therefore, a robust awareness of 5-ALA potentialities and pitfalls in recurrent GBM surgery should be considered for a cognizant surgical strategy. Further clinical trials could confirm the results of the present meta-analysis.

5-Aminolevulinic Acid False-Positive Rates in Newly Diagnosed and Recurrent Glioblastoma. Do Pseudoprogression and Radionecrosis Play a Role? A Meta-Analysis / Ricciardi, L.; Sturiale, C. L.; Scerrati, A.; Stifano, V.; Somma, T.; Ius, T.; Trungu, S.; Acqui, M.; Raco, A.; Miscusi, M.; Della Pepa, G. M.. - In: FRONTIERS IN ONCOLOGY. - ISSN 2234-943X. - 12:(2022), pp. 1-6. [10.3389/fonc.2022.848036]

5-Aminolevulinic Acid False-Positive Rates in Newly Diagnosed and Recurrent Glioblastoma. Do Pseudoprogression and Radionecrosis Play a Role? A Meta-Analysis

Ricciardi L.
Primo
;
Trungu S.
;
Acqui M.;Raco A.;Miscusi M.;
2022

Abstract

Background: Several studies have confirmed the impact of 5-aminolevulinic acid (5-ALA) on the extent of resection in newly diagnosed glioblastoma (GBM). However, there are controversies on the 5-ALA fluorescence status in recurrent GBM surgery, with specific reference to pseudoprogression or radionecrosis; therefore, the safety and accuracy of surgical planning in 5-ALA-assisted procedures in the recurrent context are still unclear. Materials and Methods: This is a systematic review and meta-analysis of comparative studies on the use of 5-ALA in newly diagnosed and recurrent GBM, consistently conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Data on fluorescence status and correlation between fluorescence and histological findings were collected. We performed a meta-analysis of proportions to estimate the pooled rates of each outcome. Results: Three online medical databases (PubMed, Scopus, Cochrane Library) were screened, 448 articles were evaluated, and 3 papers were finally included for data analysis. Fluorescence rate was not different between newly diagnosed and recurrent GBM [p = 0.45; odds ratio (OR): 1.23; 95% CI: 0.72–2.09; I2 = 0%], while the rate of 5-ALA fluorescence-positive areas not associated with histological findings of GBM cells was higher in recurrent GBM (p = 0.04; OR: 0.24; 95% CI: 0.06–0.91; I2 = 19%). Furthermore, there were no cases of radionecrosis in false-positive samples, while inflammation and signs of pseudoprogression were found in 81.4% of the cases. Discussion and Conclusions: Therefore, a robust awareness of 5-ALA potentialities and pitfalls in recurrent GBM surgery should be considered for a cognizant surgical strategy. Further clinical trials could confirm the results of the present meta-analysis.
2022
5-ala fluorescence; glioblastoma; high-grade glioma (hgg); pseudoprogression; radionecrosis; recurrent glioblastoma
01 Pubblicazione su rivista::01a Articolo in rivista
5-Aminolevulinic Acid False-Positive Rates in Newly Diagnosed and Recurrent Glioblastoma. Do Pseudoprogression and Radionecrosis Play a Role? A Meta-Analysis / Ricciardi, L.; Sturiale, C. L.; Scerrati, A.; Stifano, V.; Somma, T.; Ius, T.; Trungu, S.; Acqui, M.; Raco, A.; Miscusi, M.; Della Pepa, G. M.. - In: FRONTIERS IN ONCOLOGY. - ISSN 2234-943X. - 12:(2022), pp. 1-6. [10.3389/fonc.2022.848036]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1622482
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