title: Outcomes after combined use of intraoperative MRI and 5-aminolevulinic acid in high-grade glioma surgery.
abstract: BACKGROUND
  Previous studies have shown the individual benefits of 5-aminolevulinic acid (5-ALA) and intraoperative (i)MRI in enhancing survival for patients with high-grade glioma. In this retrospective study, we compare rates of progression-free and overall survival between patients who underwent surgical resection with the combination of 5-ALA and iMRI and a control group without iMRI.
  
  
  METHODS
  In 200 consecutive patients with high-grade gliomas, we recorded age, sex, World Health Organization tumor grade, and pre- and postoperative Karnofsky performance status (good ≥80 and poor <80). A 0.15-Tesla magnet was used for iMRI; all patients operated on with iMRI received 5-ALA. Overall and progression-free survival rates were compared using multivariable regression analysis.
  
  
  RESULTS
  Median overall survival was 13.8 months in the non-iMRI group and 17.9 months in the iMRI group (P = .043). However, on identifying confounding variables (ie, KPS and resection status) in this univariate analysis, we then adjusted for these confounders in multivariate analysis and eliminated this distinction in overall survival (hazard ratio: 1.23, P = .34, 95% CI: 0.81, 1.86). Although 5-ALA enhanced the achievement of gross total resection (odds ratio: 3.19, P = .01, 95% CI: 1.28, 7.93), it offered no effect on overall or progression-free survival when adjusted for resection status.
  
  
  CONCLUSIONS
  Gross total resection is the key surgical variable that influences progression and survival in patients with high-grade glioma and more likely when surgical adjuncts, such as iMRI in combination with 5-ALA, are used to enhance resection.
authors: Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.).
authors: Bawarjan
authors: B
authors: Schatlo
authors: Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.).
authors: Javier
authors: J
authors: Fandino
authors: Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.).
authors: Nicolas R
authors: NR
authors: Smoll
authors: Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.).
authors: Oliver
authors: O
authors: Wetzel
authors: Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.).
authors: Luca
authors: L
authors: Remonda
authors: Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.).
authors: Serge
authors: S
authors: Marbacher
authors: Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.).
authors: Wolfgang
authors: W
authors: Perrig
authors: Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.).
authors: Hans
authors: H
authors: Landolt
authors: Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.).
authors: Ali-Reza
authors: AR
authors: Fathi
mesh_terms: D000622:Aminolevulinic Acid; D001932:Brain Neoplasms / Q000601:surgery*; D003287:Contrast Media; D018572:Disease-Free Survival; D005260:Female; D005910:Glioma / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D000622:Aminolevulinic Acid
keywords: 5-aminolevulinic acid; glioblastoma; glioma surgery; intraoperative MRI; intraoperative imaging