Low-Grade Glioma with Foci of Early Transformation Does Not Necessarily Require Adjuvant Therapy After Radical Surgical Resection

Al‐Tamimi, Yahia; Palin, Martin S.; Patankar, Tufail; Macmullen-Price, Jeremy; O’Hara, Daniel; Loughrey, Carmel; Chakrabarty, Aruna; Ismail, Azzam; Roberts, Paul; Duffau, Hugues; Goodden, John; Chumas, Paul

doi:10.1016/j.wneu.2017.10.172

Cited by 17 publications

(15 citation statements)

References 25 publications

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“…A shorter period may be expected for malignant transformation in patients with fluorescent low-grade gliomas. 25,26 In the present article, 6 (25%) of the 24 confirmed cases of grade-II astrocytoma, and 1 (14.2%) of the 7 cases of oligodendroglioma, were 5-ALA positive. These patients had a minimum follow-up of 2 years, and showed no signs of disease progression or differentiation until now.…”

Section: Discussionsupporting

confidence: 50%

Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Silva

Ramina

Neto

et al. 2022

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Introduction Fluorescence guidance with 5-aminolevulinic acid (5-ALA) is a safe and reliable tool in total gross resection of intracranial tumors, especially malignant gliomas and cases of metastasis. In the present retrospective study, we have analyzed 5-ALA-induced fluorescence findings in different central nervous system (CNS) lesions to expand the indications of its use in differential diagnoses. Objectives To describe the indications and results of 5-ALA fluorescence in a series of 255 cases. Methods In 255 consecutive cases, we recorded age, gender, intraoperative 5-ALA fluorescence tumor response, and 5-ALA postresection status, as well the complications related to the method. Postresection was classified as ‘5-ALA free’ or ‘5-ALA residual’. The diagnosis of histopathological tumor was established according to the current classification of the World Health Organization (WHO). Results There were 195 (76.4%) 5-ALA positive cases, 124 (63.5%) of whom underwent the ‘5-ALA free’ resection. The findings in the positive cases were: 135 gliomas of all grades; 19 meningiomas; 4 hemangioblastomas; 1 solitary fibrous tumor; 27 metastases; 2 diffuse large B cell lymphomas; 2 cases of radionecrosis; 1 inflammatory disease; 2 cases of gliosis; 1 cysticercosis; and 1 immunoglobulin G4-related disease. Conclusion Fluorescence with 5-ALA can be observed in lesions other than malignant gliomas or metastases, including meningiomas, hemangioblastomas, pilocytic astrocytomas, and lymphomas. Although there is need for further evidence for the use of 5-ALA beyond high-grade gliomas, it may be a safe and reliable tool to improve resection in positive tumors or to guide the histopathologic analysis in biopsies.

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Section: Discussionsupporting

confidence: 50%

Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Silva

Ramina

Neto

et al. 2022

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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“…The current study shows that ALA-positivity may be a tool to help the surgeon exploit that opportunity and potentially eradicate a pre-malignant or an “in situ” malignancy within a larger zone of LGG, moving closer to the ideal of a ‘preventive surgical neurooncology’. 1,7-8 The current study will also stimulate the development of other fluorescent modalities, such as indocyanine green (ICG), which is highly sensitive, 9 and could potentially detect premalignant foci within a larger LGG. Taken together, the data reported here will strengthen the argument for aggressive, complete surgical removal of LGGs whenever possible.…”

Section: Commentsmentioning

confidence: 94%

“…Or were these anaplastic foci, representing early malignant transformation, not yet detectable by histology, but detectably by pathophysiology? 1…”

Section: Commentsmentioning

confidence: 99%

Is Visible Aminolevulinic Acid-Induced Fluorescence an Independent Biomarker for Prognosis in Histologically Confirmed (World Health Organization 2016) Low-Grade Gliomas?

et al. 2018

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“…Some authors argued that even in cases with foci of anaplasia imbedded in low-grade glioma, the total resection is sufficient for a long-term PFS, and no adjuvant treatment is needed; but this is not the standard of care as the authors already mentioned at the conclusions [74].…”

Section: Adjuvant Treatmentmentioning

confidence: 99%

Diffuse Astrocytoma and Oligodendroglioma: An Integrated Diagnosis and Management

Florian¹,

Şuşman²

2019

Glioma - Contemporary Diagnostic and Therapeutic Approaches

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For the first time, the WHO classification of brain tumors has introduced molecular parameters in the diagnosis of brain tumors. Together with embryonal tumors, the diffuse gliomas have suffered significant changes in diagnosis, prognosis, and response to treatment. A new concept of "integrated diagnosis" comes to combine the classical diagnosis with the molecular one. While it is still impossible to disregard the histopathological component, according to the new rule ("molecular beats histology") makes molecular parameters dominant in the final diagnosis. Currently, the diffuse gliomas (oligodendroglial or astrocytic) are nosologically closer than the astrocytomas with a diffuse growth pattern, and the astrocytomas with a more circumscribed growth pattern defined by the presence of the IDH mutation. The family tree was redefined by the presence of the IDH mutation and of the 1p/19q codeletion. The implementation of this new concept in clinical practice will improve patient management, as well as the design of clinical trials and experimental studies. This must also be seen as a model for diagnosis setting in the new molecular era.

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Low-Grade Glioma with Foci of Early Transformation Does Not Necessarily Require Adjuvant Therapy After Radical Surgical Resection

Cited by 17 publications

References 25 publications

Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Is Visible Aminolevulinic Acid-Induced Fluorescence an Independent Biomarker for Prognosis in Histologically Confirmed (World Health Organization 2016) Low-Grade Gliomas?

Diffuse Astrocytoma and Oligodendroglioma: An Integrated Diagnosis and Management

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