Fluorescein-guided resection of newly diagnosed high-grade glioma: Impact on extent of resection and outcome.

Introduction: Maximal resection of high-grade glioma (HGG) improves progression-free survival (PFS) and overall survival (OS). Fluorescein sodium (FL) in combination with the YELLOW 560 ​nm filter (Carl Zeiss Meditec, Germany) is a safe and feasible method of visualizing residual tumor tissue during brain tumor resection. Research question: We hypothesized that use of FL positively influenced the volumetric extent of resection (EOR), PFS, and OS in patients undergoing resection of a newly diagnosed HGG. Materials and method: Using a prospective HGG registry, we identified 347 patients (median age 62.4 years; 141 women) with preoperative high-quality magnetic resonance images for volumetric analysis. Resection was performed under white light in n ​= ​151 (43.5%, white-light group) and under FL-guidance in n ​= ​196 (56.5%, FL group). Sex, age, presurgical Karnofsky Performance Index (KPI), O6-Methylguanin-DNA-Methyltransferase-Gene (MGMT) status, and adjuvant treatment modalities were well balanced between the groups. Volumetric analysis was performed by quantifying pre- and postoperative tumor volume based on gadolinium-enhanced T1 sequences in a blinded fashion. Results: In the FL group, postoperative tumor volume was significantly smaller (p ​= ​0.003); accordingly, quantitative EOR was significantly larger (p ​= ​0.003). Significantly more complete resections were achieved in the FL group than in the white-light group (p ​= ​0.003). The FL group showed significantly longer PFS (p ​= ​0.020) and OS (p ​= ​0.015, log rank testing). Multivariate Cox regression modelling showed age, presurgical KPI, MGMT status, and FL-guided resection to be independent prognostic factors for survival. Discussion and conclusion: Compared to white-light resection, FL-guided resection of newly diagnosed HGG significantly improved EOR and prolonged OS.