title: Semi-Automated Volumetric and Morphological Assessment of Glioblastoma Resection with Fluorescence-Guided Surgery.
abstract: Glioblastoma (GBM) neurosurgical resection relies on contrast-enhanced MRI-based neuronavigation. However, it is well-known that infiltrating tumor extends beyond contrast enhancement. Fluorescence-guided surgery (FGS) using 5-aminolevulinic acid (5-ALA) was evaluated to improve extent of resection (EOR) of GBMs. Preoperative morphological tumor metrics were also assessed.
  
  
  
  Thirty patients from a phase II trial evaluating 5-ALA FGS in newly diagnosed GBM were assessed. Tumors were segmented preoperatively to assess morphological features as well as postoperatively to evaluate EOR and residual tumor volume (RTV).
  
  
  
  Median EOR and RTV were 94.3 % and 0.821 cm(3), respectively. Preoperative surface area to volume ratio and RTV were significantly associated with overall survival, even when controlling for the known survival confounders.
  
  
  
  This study supports claims that 5-ALA FGS is helpful at decreasing tumor burden and prolonging survival in GBM. Moreover, morphological indices are shown to impact both resection and patient survival.
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Cordova
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA.
authors.forename: Saumya S
authors.initials: SS
authors.lastname: Gurbani
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Holder
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA.|Winship Cancer Institute of Emory University, Atlanta, GA, 30322, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Olson
authors.affiliation: Department of Radiation Oncology, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA.
authors.forename: Eduard
authors.initials: E
authors.lastname: Schreibmann
authors.affiliation: Department of Biostatistics, Emory University School of Public Health, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA.
authors.forename: Ran
authors.initials: R
authors.lastname: Shi
authors.affiliation: Department of Biostatistics, Emory University School of Public Health, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Radiation Oncology, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA.|Winship Cancer Institute of Emory University, Atlanta, GA, 30322, USA.
authors.forename: Hui-Kuo G
authors.initials: HK
authors.lastname: Shu
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA. hshim@emory.edu.|Winship Cancer Institute of Emory University, Atlanta, GA, 30322, USA. hshim@emory.edu.
authors.forename: Hyunsuk
authors.initials: H
authors.lastname: Shim
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA. constantinos.hadjipanayis@mountsinai.org.|Winship Cancer Institute of Emory University, Atlanta, GA, 30322, USA. constantinos.hadjipanayis@mountsinai.org.|Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, 10 Union Square, 5th Floor, Suite 5E, New York, NY, 10003, USA. constantinos.hadjipanayis@mountsinai.org.
authors.forename: Costas G
authors.initials: CG
authors.lastname: Hadjipanayis
mesh_terms: D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000627:therapeutic use; D001331:Automation; D001932:Brain Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D023381:Endpoint Determination; D005260:Female; D005453:Fluorescence; D005909:Glioblastoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D025321:Surgery, Computer-Assisted / Q000379:methods*; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D000622:Aminolevulinic Acid
keywords: 5-Aminolevulinic acid (5-ALA); Extent of resection (EOR); Fluorescence-guided surgery (FGS); Glioblastoma (GBM); Safety; Tumor morphology; Tumor segmentation