5-Aminolevulinic Acid False-Positive Rates in Newly Diagnosed and Recurrent Glioblastoma: Do Pseudoprogression and Radionecrosis Play a Role? A Meta-Analysis
BackgroundSeveral 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 radionecr...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-02-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.848036/full |
| _version_ | 1828864787880083456 |
|---|---|
| author | Luca Ricciardi Carmelo Lucio Sturiale Carmelo Lucio Sturiale Alba Scerrati Alba Scerrati Vito Stifano Vito Stifano Teresa Somma Tamara Ius Sokol Trungu Sokol Trungu Michele Acqui Antonino Raco Massimo Miscusi Giuseppe Maria Della Pepa Giuseppe Maria Della Pepa |
| author_facet | Luca Ricciardi Carmelo Lucio Sturiale Carmelo Lucio Sturiale Alba Scerrati Alba Scerrati Vito Stifano Vito Stifano Teresa Somma Tamara Ius Sokol Trungu Sokol Trungu Michele Acqui Antonino Raco Massimo Miscusi Giuseppe Maria Della Pepa Giuseppe Maria Della Pepa |
| author_sort | Luca Ricciardi |
| collection | DOAJ |
| description | BackgroundSeveral 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 MethodsThis 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.ResultsThree 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 ConclusionsTherefore, 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. |
| first_indexed | 2024-12-13T04:15:02Z |
| format | Article |
| id | doaj.art-1ef1ff8e872b4e0a8b8065b51b5e9fb3 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-13T04:15:02Z |
| publishDate | 2022-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-1ef1ff8e872b4e0a8b8065b51b5e9fb32022-12-21T23:59:55ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-02-011210.3389/fonc.2022.8480368480365-Aminolevulinic Acid False-Positive Rates in Newly Diagnosed and Recurrent Glioblastoma: Do Pseudoprogression and Radionecrosis Play a Role? A Meta-AnalysisLuca Ricciardi0Carmelo Lucio Sturiale1Carmelo Lucio Sturiale2Alba Scerrati3Alba Scerrati4Vito Stifano5Vito Stifano6Teresa Somma7Tamara Ius8Sokol Trungu9Sokol Trungu10Michele Acqui11Antonino Raco12Massimo Miscusi13Giuseppe Maria Della Pepa14Giuseppe Maria Della Pepa15Division of Neurosurgery, Sant’Andrea Hospital, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, Rome, ItalyInstitute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, Rome, ItalyDivision of Neurosurgery, Catholic University of Rome, Rome, ItalyNeurosurgery Department, S. Anna University Hospital, Ferrara, ItalyDepartment of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, ItalyInstitute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, Rome, ItalyDivision of Neurosurgery, Catholic University of Rome, Rome, ItalyDivision of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, ItalyDivision of Neurosurgery, Neuroscience Department, University Hospital of Udine, Udine, ItalyDivision of Neurosurgery, Sant’Andrea Hospital, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, Rome, ItalyNeurosurgery Unit, Cardinal G. Panico Hospital, Tricase, ItalyDivision of Neurosurgery, Sant’Andrea Hospital, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, Rome, ItalyDivision of Neurosurgery, Sant’Andrea Hospital, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, Rome, ItalyDivision of Neurosurgery, Sant’Andrea Hospital, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, Rome, ItalyInstitute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, Rome, ItalyDivision of Neurosurgery, Catholic University of Rome, Rome, ItalyBackgroundSeveral 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 MethodsThis 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.ResultsThree 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 ConclusionsTherefore, 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.https://www.frontiersin.org/articles/10.3389/fonc.2022.848036/fullglioblastomahigh-grade glioma (HGG)recurrent glioblastoma5-ALA fluorescencepseudoprogressionradionecrosis |
| spellingShingle | Luca Ricciardi Carmelo Lucio Sturiale Carmelo Lucio Sturiale Alba Scerrati Alba Scerrati Vito Stifano Vito Stifano Teresa Somma Tamara Ius Sokol Trungu Sokol Trungu Michele Acqui Antonino Raco Massimo Miscusi Giuseppe Maria Della Pepa Giuseppe Maria Della Pepa 5-Aminolevulinic Acid False-Positive Rates in Newly Diagnosed and Recurrent Glioblastoma: Do Pseudoprogression and Radionecrosis Play a Role? A Meta-Analysis Frontiers in Oncology glioblastoma high-grade glioma (HGG) recurrent glioblastoma 5-ALA fluorescence pseudoprogression radionecrosis |
| title | 5-Aminolevulinic Acid False-Positive Rates in Newly Diagnosed and Recurrent Glioblastoma: Do Pseudoprogression and Radionecrosis Play a Role? A Meta-Analysis |
| title_full | 5-Aminolevulinic Acid False-Positive Rates in Newly Diagnosed and Recurrent Glioblastoma: Do Pseudoprogression and Radionecrosis Play a Role? A Meta-Analysis |
| title_fullStr | 5-Aminolevulinic Acid False-Positive Rates in Newly Diagnosed and Recurrent Glioblastoma: Do Pseudoprogression and Radionecrosis Play a Role? A Meta-Analysis |
| title_full_unstemmed | 5-Aminolevulinic Acid False-Positive Rates in Newly Diagnosed and Recurrent Glioblastoma: Do Pseudoprogression and Radionecrosis Play a Role? A Meta-Analysis |
| title_short | 5-Aminolevulinic Acid False-Positive Rates in Newly Diagnosed and Recurrent Glioblastoma: Do Pseudoprogression and Radionecrosis Play a Role? A Meta-Analysis |
| title_sort | 5 aminolevulinic acid false positive rates in newly diagnosed and recurrent glioblastoma do pseudoprogression and radionecrosis play a role a meta analysis |
| topic | glioblastoma high-grade glioma (HGG) recurrent glioblastoma 5-ALA fluorescence pseudoprogression radionecrosis |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.848036/full |
| work_keys_str_mv | AT lucaricciardi 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT carmeloluciosturiale 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT carmeloluciosturiale 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT albascerrati 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT albascerrati 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT vitostifano 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT vitostifano 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT teresasomma 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT tamaraius 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT sokoltrungu 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT sokoltrungu 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT micheleacqui 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT antoninoraco 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT massimomiscusi 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT giuseppemariadellapepa 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis AT giuseppemariadellapepa 5aminolevulinicacidfalsepositiveratesinnewlydiagnosedandrecurrentglioblastomadopseudoprogressionandradionecrosisplayaroleametaanalysis |