Semi-Automated Volumetric and Morphological Assessment of Glioblastoma Resection with Fluorescence-Guided Surgery

• Type of Material: Article
• Authors: J. Scott Cordova, Emory University; Saumya S. Gurbani, Emory University; Chad Holder, Emory University; Jeffrey Olson, Emory University; Eduard Schreibmann, Emory University; Ran Shi, Emory University; Ying Guo, Emory University; Hui-Kuo Shu, Emory University; Hyunsuk Shim, Emory University; Constantinos Hadjipanayis, Emory University
• Language: English
• Date: 2015-10-13
• Publisher: Springer Verlag (Germany)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 World Molecular Imaging Society.
• Final Published Version (URL): http://dx.doi.org/10.1007/s11307-015-0900-2
• Title of Journal or Parent Work: Molecular Imaging and Biology
• ISSN: 1536-1632
• Volume: 18
• Issue: 3
• Start Page: 454
• End Page: 462
• Grant/Funding Information: This work was supported by National Institute of Health grants R21 CA141836 (CGH/CAH/HS), a predoctoral fellowship F31 CA180319 (JSC), and a research grant from Nx Development Corp. (CGH).
• Keywords: Neurosurgery; 5-Aminolevulinic acid (5-ALA); Safety; Extent of resection (EOR); Glioblastoma (GBM); Tumor segmentation; Fluorescence-guided surgery (FGS); Tumor morphology
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

Purpose: 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. Procedures: 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). Results: Median EOR and RTV were 94.3 % and 0.821 cm3, respectively. Preoperative surface area to volume ratio and RTV were significantly associated with overall survival, even when controlling for the known survival confounders. Conclusions: 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.