SURG-09. AGENTS FOR FLUORESCENCE GUIDED GLIOMA SURGERY: REVIEW OF PRECLINICAL AND CLINICAL RESULTS

Abstract

INTRODUCTION: Gross total resection (GTR) of gliomas is associated with improved survival. Fluorescence guided surgery (FGS) is a technique used to enhance visualization of tumor margins in order to increase the extent of tumor resection. The aim of this paper was to systematically review all pre-clinical and clinical studies that investigated fluorescent agents for application in FGS of gliomas. METHODS: We searched Pubmed and Embase databases for all potentially relevant studies up to march 2016. We compared the usefulness of the fluorescent agents by assessing the following outcomes: GTR rate, overall and progression free survival, sensitivity and specificity in discriminating tumor and healthy brain tissue, tumor-tonormal ratio (TNR) of fluorescent signal and incidence of adverse events. RESULTS: The search strategy resulted in 1696 articles that were screened by titles and abstracts. After full-text screening, 98 articles fulfilled the inclusion criteria. Clinically, forty-four studies, including two randomized control trails (RCTs), tested 5-ALA, eleven studies tested fluorescein, two studies tested indocyanine green, one study tested hypericin and five studies tested endogenous fluorophores in FGS of gliomas. Twenty-four other fluorescent agents were identified that have only been tested pre-clinically. Overall, 5-ALA and fluorescein offer the best improvement in GTR and survival of all clinically tested agents. Molecular targeting agents (e.g. fluoro- phore labeled anti-EGFR antibodies) offer promising results on histological accuracy but are still in the pre-clinical phase. CONCLUSION: For FGS in glioma surgery, 5-ALA and fluorescein offer the best improvement in GTR rate and survival. However, several pre-clinically tested agents may be interesting future alternatives.