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The role of 5‐aminolevulinic acid in enhancing surgery for high‐grade glioma, its current boundaries, and future perspectives: A systematic review
Author(s) -
Mansouri Alireza,
Mansouri Sheila,
Hachem Laureen D.,
Klironomos George,
Vogelbaum Michael A.,
Bernstein Mark,
Zadeh Gelareh
Publication year - 2016
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30088
Subject(s) - medicine , glioma , adverse effect , medline , prospective cohort study , randomized controlled trial , biopsy , systematic review , surgery , intensive care medicine , cancer research , political science , law
5‐Aminolevulinic acid (5‐ALA) has been approved as an intraoperative adjunct in glioma surgery in Europe, but not North America. A systematic review was conducted to assess the evidence regarding 5‐ALA as a surgical adjunct. The MEDLINE, EMBASE, and CENTRAL databases were searched, using terms relevant to “5‐ALA” and “high‐grade gliomas.” Included studies were based on adults aged ≥18 years who underwent surgical resection/biopsy. No language or date limitations were used. Forty‐three studies (1830 patients) were identified. Thirty‐six were coordinated by European countries, 2 were in the United States, and none were in Canada. One was randomized, 28 were prospective, and 14 were retrospective. Twenty‐six studies assessed the utility of 5‐ALA as a diagnostic tool, 24 assessed its influence on the extent of resection (EOR), 9 assessed survival, and 22 reported adverse events. 5‐ALA had high sensitivity and positive predictive value, whereas its specificity increased with additional adjuncts. The EOR increased with 5‐ALA, but only progression‐free survival was significantly influenced. Reporting of adverse events was not systematic. The use of 5‐ALA improved tumor visualization and thus enabled a greater EOR and perhaps increased survival. However, additional adjuncts may be necessary for maximizing the specificity of resection and patient safety. Additional parameters, such as patient quality of life and health economic analyses, would be informative. Thus, additional systematic collection of prospective evidence may be necessary for the global incorporation of this potentially valuable surgical adjunct into routine practice. Cancer 2016;122:2469–78 . © 2016 American Cancer Society .