Evidence map›Paper›PMID 37335962›Full record

ArticleJournal of clinical oncology : official journal of the American Society of Clinical Oncology2023

Intraoperative MRI-Guided Resection Is Not Superior to 5-Aminolevulinic Acid Guidance in Newly Diagnosed Glioblastoma: A Prospective Controlled Multicenter Clinical Trial.

Constantin Roder, Walter Stummer, Jan Coburger, Moritz Scherer, Patrick Haas, Christian von der Brelie, Marcel Alexander Kamp, Mario Löhr, Christina A Hamisch, Marco Skardelly and 20 more

Open access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
46citing papers in PubMed, 4 pooled it
17.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

46 citing papers in PubMed, 4 syntheses or guidelines pooled it, 59 citations in OpenAlex.

  1. Pooled it
  2. Guideline
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  5. Trial
  6. Review
  7. Review
  8. Contemporary surgical strategies for resection of intracranial gliomas.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2026
    Review
  9. Investigation of the impact of resveratrol on sublethal-dose ALA-PDT in glioblastoma cells.Photochemical & photobiological sciences : Official journal of the European Photochemistry Association and the European Society for Photobiology · 2026
    Article
  10. Article
  11. Article
  12. Review
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  14. Image-Guided Brain Tumor Surgery.Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer · 2026
    Review
  15. Review
  16. Article
  17. Observational
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

30 authors at 16 institutions in 3 countries.

Constantin RoderDepartment of Neurosurgery, University Hospital Tübingen, Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, Eberhard-Karls-University, Tübingen, Germany.ORCID 0000-0003-4487-2807
Walter StummerDepartment of Neurosurgery, University Hospital Münster, Westphalian-Wilhelms-University, Münster, Germany.
Jan CoburgerDepartment of Neurosurgery, University Hospital Ulm/Günzburg, University of Ulm, Günzburg, Germany.ORCID 0000-0002-3677-8258
Moritz SchererDepartment of Neurosurgery, University Hospital Heidelberg, Rupprecht-Karls-University, Heidelberg, Germany.ORCID 0000-0003-1203-9351
Patrick HaasDepartment of Neurosurgery, University Hospital Tübingen, Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, Eberhard-Karls-University, Tübingen, Germany.ORCID 0000-0001-7728-2091
Christian von der BrelieDepartment of Neurosurgery, University Hospital Göttingen, Georg-August-University, Göttingen, Germany.
Marcel Alexander KampDepartment of Neurosurgery, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.ORCID 0000-0002-1252-2944
Mario LöhrDepartment of Neurosurgery, University Hospital Würzburg, Julius-Maximilians-University, Würzburg, Germany.
Christina A HamischDepartment of Neurosurgery, University Hospital Cologne, University of Cologne, Cologne, Germany.
Marco SkardellyDepartment of Neurosurgery, University Hospital Tübingen, Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, Eberhard-Karls-University, Tübingen, Germany.ORCID 0000-0002-3870-6872
Torben ScholzDepartment of Neurosurgery, Asklepios Klinik Nord-Heidberg, Hamburg, Germany.ORCID 0009-0001-6073-6859
Stephanie SchipmannDepartment of Neurosurgery, University Hospital Münster, Westphalian-Wilhelms-University, Münster, Germany.
Julian RathertDepartment of Neurosurgery, Helios Hospital Erfurt, Erfurt, Germany.
Catrin Marlene BrandDepartment of Neurosurgery, Municipal Hospital Dresden, Dresden, Germany.
Andrej PalaDepartment of Neurosurgery, University Hospital Ulm/Günzburg, University of Ulm, Günzburg, Germany.
Ulrike ErnemannDepartment of Neuroradiology, University Hospital Tübingen, Eberhards-Karls-University, Tübingen, Germany.
Florian StockhammerDepartment of Neurosurgery, Municipal Hospital Dresden, Dresden, Germany.ORCID 0000-0002-0525-5956
Rüdiger GerlachDepartment of Neurosurgery, Helios Hospital Erfurt, Erfurt, Germany.
Paul KremerDepartment of Neurosurgery, Asklepios Klinik Nord-Heidberg, Hamburg, Germany.
Roland GoldbrunnerDepartment of Neurosurgery, University Hospital Cologne, University of Cologne, Cologne, Germany.
Ralf-Ingo ErnestusDepartment of Neurosurgery, University Hospital Würzburg, Julius-Maximilians-University, Würzburg, Germany.
Michael SabelDepartment of Neurosurgery, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
Veit RohdeDepartment of Neurosurgery, University Hospital Göttingen, Georg-August-University, Göttingen, Germany.
Ghazaleh TabatabaiDepartment of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, German Cancer Consortium (DKTK), Partner Site Tübingen, Eberhard-Karls-University, Tübingen, Germany.ORCID 0000-0002-3542-8782
Peter MartusDepartment of Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-University, Tübingen, Germany.ORCID 0000-0002-5386-5732
Sotirios BisdasLysholm Department of Neuroradiology, The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom.ORCID 0000-0001-9930-5549
Oliver GanslandtDepartment of Neurosurgery, Municipal Hospital Stuttgart, Stuttgart, Germany.ORCID 0000-0002-6794-1900
Andreas UnterbergDepartment of Neurosurgery, University Hospital Heidelberg, Rupprecht-Karls-University, Heidelberg, Germany.
Christian Rainer WirtzDepartment of Neurosurgery, University Hospital Ulm/Günzburg, University of Ulm, Günzburg, Germany.ORCID 0000-0001-8358-1813
Marcos TatagibaDepartment of Neurosurgery, University Hospital Tübingen, Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, Eberhard-Karls-University, Tübingen, Germany.
University of Tübingen · DEUniversität Ulm · DEAsklepios Kliniken Hamburg · DEDüsseldorf University Hospital · DEHeidelberg University · DEHelios Klinikum Erfurt · DEStädtisches Klinikum Dresden · DEUniversitätsklinikum Würzburg · DEUniversity of Cologne · DEHaukeland University Hospital · NOHertie Institute for Clinical Brain Research · DEJohanniter-Krankenhaus Bonn · DEKlinikum Stuttgart · DEUniversity College London Hospitals NHS Foundation Trust · GBUniversity Hospital Münster · DEUniversity of Göttingen · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeProspective data suggested a superiority of intraoperative MRI (iMRI) over 5-aminolevulinic acid (5-ALA) for achieving complete resections of contrast enhancement in glioblastoma surgery. We investigated this hypothesis in a prospective clinical trial and correlated residual disease volumes with clinical outcome in newly diagnosed glioblastoma.

methodsThis is a prospective controlled multicenter parallel-group trial with two center-specific treatment arms (5-ALA and iMRI) and blinded evaluation. The primary end point was complete resection of contrast enhancement on early postoperative MRI. We assessed resectability and extent of resection by an independent blinded centralized review of preoperative and postoperative MRI with 1-mm slices. Secondary end points included progression-free survival (PFS) and overall survival (OS), patient-reported quality of life, and clinical parameters.

resultsWe recruited 314 patients with newly diagnosed glioblastomas at 11 German centers. A total of 127 patients in the 5-ALA and 150 in the iMRI arm were analyzed in the as-treated analysis. Complete resections, defined as a residual tumor ≤0.175 cm³, were achieved in 90 patients (78%) in the 5-ALA and 115 (81%) in the iMRI arm (

conclusionWe could not confirm superiority of iMRI over 5-ALA for achieving complete resections. Neurosurgical interventions in newly diagnosed glioblastoma shall aim for safe complete resections with 0 cm³ contrast-enhancing residual disease, as any other residual tumor volume is a negative predictor for PFS and OS.

Indexed as

Brain NeoplasmsGlioblastomaAminolevulinic AcidHumansMagnetic Resonance ImagingNeoplasm, ResidualProspective StudiesQuality of LifeAminolevulinic Acid

Identifiers

PMID37335962
PMCPMC10730068
OpenAlexW4381189214

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.