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4 november 2015: Bron: PLoS One. 2013; 8(5): e63682. Published online 2013 May 28. doi: 10.1371/journal.pone.0063682
Het verwijderen van een hooggradige hersentumor - glioma blastoma, met hulp van 5-aminolevulinic acid (5-ALA) dat de tumorcellen doet oplichten geeft betere resultaten op volledige verwijdering van het tumorweefsel, langere ziektevrije tijd en betere overall overleving in vergelijking met een conventionele operatie waarbij gebruik wordt gemaakt van MRI begeleiding en open schedel operatie. Dit blijkt uit een grote reviewstudie van gerandomiseerde en prospectieve studies.
Uit alle studies samen blijkt opereren met 5-aminolevulinic acid (5-ALA) statistisch significant betere resultaten te geven op zowel meer verwijdering van tumorweefsel, ziektevrije tijd en mediane overall overleving. Dit gaat niet op voor laaggradige hersentumoren omdat deze niet oplichten wegens gebrek aan stofje dat tumorcellen doet oplichten.
Hier de hoeveelheid studies die meegenomen zijn in de meta analyse:
De overleving uit enkele studies:
Based on available literature, there is level 2 evidence that 5-ALA-guided surgery is more effective than conventional neuronavigation-guided surgery in increasing diagnostic accuracy and extent of tumor resection, enhancing quality of life, or prolonging survival in patients with high-grade malignant gliomas.
PLoS One. 2013; 8(5): e63682.
Intraoperative Fluorescence-Guided Resection of High-Grade Malignant Gliomas Using 5-Aminolevulinic Acid–Induced Porphyrins: A Systematic Review and Meta-Analysis of Prospective Studies
Shiguang Zhao,
#1,2,* Jianing Wu,
#1,2 Chunlei Wang,
1,2 Huailei Liu,
1,2 Xingli Dong,
3 Chen Shi,
4 Changbin Shi,
5 Yaohua Liu,
1,2 Lei Teng,
1,2 Dayong Han,
1,2 Xiaofeng Chen,
1,2 Guang Yang,
1,2 Ligang Wang,
1,2 Chen Shen,
1,2 and
Huadong Li1,2
Jonathan A. Coles, Editor
This article has been
cited by other articles in PMC.
Abstract
Background
We performed a systematic review and meta-analysis to address the (added) value of intraoperative 5-aminolevulinic acid (5-ALA)-guided resection of high-grade malignant gliomas compared with conventional neuronavigation-guided resection, with respect to diagnostic accuracy, extent of tumor resection, safety, and survival.
Methods and Findings
An electronic database search of Medline, Embase, and the Cochrane Library was undertaken. The review process followed the guidelines of the Cochrane Collaboration. 10 studies matched all selection criteria, and were thus used for qualitative synthesis. 5-ALA-guided resection demonstrated an overall sensitivity of 0.87 (95% confidence interval , 0.81–0.92), specificity of 0.89 (95% CI, 0.79–0.94), positive likelihood ratio (LR) of 7.62 (95% CI, 3.87–15.01), negative LR of 0.14 (95% CI, 0.09–0.23), and diagnostic odds ratio (OR) of 53.06 (95% CI, 18.70–150.51). Summary receiver operating characteristic curves (SROC) showed an area under curve (AUC) of 94%. Contrast-enhancing tumor was completely resected in patients assigned 5-ALA as compared with patients assigned white light. Patients in the 5-ALA group had higher 6-month progression free survival and overall survival than those in the white light group.
Conclusion
Based on available literature, there is level 2 evidence that 5-ALA-guided surgery is more effective than conventional neuronavigation-guided surgery in increasing diagnostic accuracy and extent of tumor resection, enhancing quality of life, or prolonging survival in patients with high-grade malignant gliomas.
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glioblastoom, studies, hersentumoren, kytogeendieet, 5-aminolevulinic acid (5-ALA), PDT, operatie
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