Impact of fluorescence-guided surgery on the improvement of clinical outcomes in glioblastoma patients

Background. To evaluate the clinical impact of fluorescence-guided surgery (FGS) in glioblastoma, we analyzed the clinical data of 80 consecutive patients operated on by a single surgeon with or without 5-aminolevulinic acid (5-ALA). Methods.We compared 3-dimensional volumetric extent of resection and clinical outcomes between 40 consecutive patients undergo-ing resection using a white-light (WL) microscope and 40 subsequent consecutive patients undergoing resection using FGS with 5ALA. Results. By introducing FGS, there was a significant difference in themean volumetric extent of the resection rate of T1-enhancing lesions (84.7 % in the white-light group and 97.0 % in the 5-ALA group, P .002). The complete resection rate was improved from 43 % to 80%, and the proportion of resections that were,80 % was reduced from 26 % to 4 % by FGS. The median progression-free survival was sig-nificantly better in the 5-ALA group (18.0 months vs. 6.0 months; P .001). Although the immediate postoperative functional status was slightly worse in the 5-ALA group, this trend had reversed itself by 3 months postoperatively. Conclusions. The present study adds practical evidence of the clinical impact of 5-ALA FGS on glioblastomas from the surgeon’s standpoint