Current trends in the management of glioblastoma in a French University Hospital and associated direct costs

Hénaine, Anna Maria; Paubel, N.; Ducray, François; Diebold, Gilbert; Frappaz, Didier; Guyotat, Jacques; Cartalat‐Carel, Stéphanie; Aulagner, G.; Honnorat, Jérôme; Armoiry, Xavier

doi:10.1111/jcpt.12346

Cited by 17 publications

(9 citation statements)

References 28 publications

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“…Together, these trials indicate that improved resection directly extends survival and enhances the treatment effect of radical chemo-radiotherapy. Both 5-ALA guided surgery and temozolomide based chemo-radiotherapy are being used increasingly in modern practice with a demonstrated increase in overall survival [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Local alkylating chemotherapy applied immediately after 5-ALA guided resection of glioblastoma does not provide additional benefit

et al. 2017

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Grade IV glioma is the most common and aggressive primary brain tumour. Gross total resection with 5-aminolevulinic acid (5-ALA) guided surgery combined with local chemotherapy (carmustine wafers) is an attractive treatment strategy in these patients. No previous studies have examined the benefit carmustine wafers in a treatment programme of 5-ALA guided resection followed by a temozolomide-based chemoradiotherapy protocol. The objective of this study was to examine the benefit of carmustine wafers on survival in patients undergoing 5-ALA guided resection. A retrospective cohort study of 260 patients who underwent 5-ALA resection of confirmed WHO 2007 Grade IV glioma between July 2009 and December 2014. Survival curves were calculated using the Kaplan–Meier method from surgery. The log-rank test was used to compare survival curves between groups. Cox regression was performed to identify variables predicting survival. A propensity score matched analysis was used to compare survival between patients who did and did not receive carmustine wafers while controlling for baseline characteristics. Propensity matched analysis showed no significant survival benefit of insertion of carmustine wafers over 5-ALA resection alone (HR 0.97 [0.68–1.26], p = 0.836). There was a trend to higher incidence of wound infection in those who received carmustine wafers (15.4 vs. 7.1%, p = 0.064). The Cox regression analysis showed that intraoperative residual fluorescent tumour and residual enhancing tumour on post-operative MRI were significantly predictive of reduced survival. Carmustine wafers have no added benefit following 5-ALA guided resection. Residual fluorescence and residual enhancing disease following resection have a negative impact on survival.

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Section: Discussionmentioning

confidence: 99%

Local alkylating chemotherapy applied immediately after 5-ALA guided resection of glioblastoma does not provide additional benefit

et al. 2017

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“…Numerous neurosurgical studies highlight the benefits of wide-field fluorescence-guided glial tumor resection, mainly to increase the GTR rate and progression-free survival ( 2 , 111 , 188 ). Some studies even showed increased overall survival ( 189 ).…”

Section: Instrumentation For Fluorescence-guided Resectionmentioning

confidence: 99%

Intraoperative Fluorescence Imaging for Personalized Brain Tumor Resection: Current State and Future Directions

et al. 2016

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IntroductionFluorescence-guided surgery is one of the rapidly emerging methods of surgical “theranostics.” In this review, we summarize current fluorescence techniques used in neurosurgical practice for brain tumor patients as well as future applications of recent laboratory and translational studies.MethodsReview of the literature.ResultsA wide spectrum of fluorophores that have been tested for brain surgery is reviewed. Beginning with a fluorescein sodium application in 1948 by Moore, fluorescence-guided brain tumor surgery is either routinely applied in some centers or is under active study in clinical trials. Besides the trinity of commonly used drugs (fluorescein sodium, 5-aminolevulinic acid, and indocyanine green), less studied fluorescent stains, such as tetracyclines, cancer-selective alkylphosphocholine analogs, cresyl violet, acridine orange, and acriflavine, can be used for rapid tumor detection and pathological tissue examination. Other emerging agents, such as activity-based probes and targeted molecular probes that can provide biomolecular specificity for surgical visualization and treatment, are reviewed. Furthermore, we review available engineering and optical solutions for fluorescent surgical visualization. Instruments for fluorescent-guided surgery are divided into wide-field imaging systems and hand-held probes. Recent advancements in quantitative fluorescence-guided surgery are discussed.ConclusionWe are standing on the threshold of the era of marker-assisted tumor management. Innovations in the fields of surgical optics, computer image analysis, and molecular bioengineering are advancing fluorescence-guided tumor resection paradigms, leading to cell-level approaches to visualization and resection of brain tumors.

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“…Despite the rise in studies on 5-ALA-guided surgery, cost-effectiveness analyses on this adjunct are limited. 2,20 We conducted the first systematic review on the cost-effectiveness of 5-ALA. Three primary studies were analyzed; all of which examined the perspective of a national healthcare system. Overall, while there is a paucity of high-quality data pertaining to the cost-effectiveness of 5-ALA, the currently available data suggest this adjunct is cost-effective.…”

Section: Discussionmentioning

confidence: 99%

“…Discounting rates of 0%, 3%, 5%, and 7% were applied, with ICER per LY gained ranging from €5,963/C$8,885 to €7,473/C 17 Esteves et al 1 Henaine et al 20 Mean total cost of surgery iii. Current trends in the management of GBM in a French University Hospital and associated direct costs.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The costs included were €1,000/C$1,575 per 5-ALA vial for patients <75 kg. For patients >75 kg, the cost of the 5-ALA vial was not taken into account as it was not covered by the French Table 3: Quality assessment of studies using the guidelines for economic submissions to the BMJ BMJ's guidelines checklist Slof et al 17 Esteves et al 1 Henaine et al 20 The answer to the study question is given.…”

Section: Study Characteristicsmentioning

confidence: 99%

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The Cost-Effectiveness of 5-ALA in High-Grade Glioma Surgery: A Quality-Based Systematic Review

Warsi

Zewude

Karmur

et al. 2020

Can. J. Neurol. Sci.

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Background: High-grade gliomas (HGGs) are aggressive tumors that inevitably recur due to their diffusely infiltrative nature. Intraoperative adjuncts such as 5-aminolevulinic acid (5-ALA) have shown promise in increasing extent of resection. As the prospect of increased use of 5-ALA rises, a systematic overview of the health economics of this adjunct is critical. Methods: Medline, EMBASE, Centre for Reviews and Dissemination, EconPapers, and Cochrane databases were searched for keywords relating to glioma, cost-effectiveness, and 5-ALA. Primary studies reporting on the health economics or cost-effectiveness of 5-ALA compared to white light surgery in HGG were included. Quality was assessed using the British Medical Journal guidelines. Results: Three studies were identified. All were European and conducted from the perspective of national healthcare systems. Two studies demonstrated the cost-utility of 5-ALA compared to white light (C$12,817 and C$13,508/quality-adjusted life-years (QALYs)). One assessed the cost-utility per gross total resection (C$6,813). Both these values were below the national cost-effectiveness thresholds for each respective study. The third study demonstrated no significant difference in cost of 5-ALA in glioblastoma resection (C$14,732) compared to prior to its routine use (C$15,936). The quality of these studies ranged from moderate to average. None of these studies considered patient perspective or indirect costs in their analysis. Conclusions: Growing evidence exists examining the health economic benefit of 5-ALA as an intraoperative adjunct for HGG resection. Additional studies within the Canadian context using 5-ALA, specifically incorporating patient and societal perspectives into the cost-utility analyses, are necessary to solidify this line of evidence.

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Current trends in the management of glioblastoma in a French University Hospital and associated direct costs

Cited by 17 publications

References 28 publications

Local alkylating chemotherapy applied immediately after 5-ALA guided resection of glioblastoma does not provide additional benefit

Local alkylating chemotherapy applied immediately after 5-ALA guided resection of glioblastoma does not provide additional benefit

Intraoperative Fluorescence Imaging for Personalized Brain Tumor Resection: Current State and Future Directions

The Cost-Effectiveness of 5-ALA in High-Grade Glioma Surgery: A Quality-Based Systematic Review

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