Evaluation of the influence of fluorescence surgery in patients with glioblastoma on long-term treatment results

Introduction. Glioblastoma is the most aggressive primary brain tumor, characterized by rapid progression and a median survival of no more than 12–18 months. Fluorescence-guided surgery should be of critical importance, as it allows visualization of the tumor and facilitates its complete removal, which is essential for increasing survival. Purpose of the study. Comparative analysis of remote treatment results in patients with glioblastoma using fluorescent surgery and white light surgery without fluorophores. Material and methods. A single-center, retrospective study included 54 patients with newly diagnosed glioblastoma (24 patients in the main group with fluorescent surgery; 30 patients in the control group with white light surgery without fluorophores). In the main group, 11 patients used 5 ALA (20 mg/kg) orally, and 13 patients received Photoditazine (1 mg/kg) intravenously. Preoperative magnetic resonance imaging (MRI) data allowed complete resection of contrast-positive tumor areas, according to the operating surgeon, in all patients. The groups were representative in terms of gender, age, tumor size, preoperative Karnofsky index, tumor resection radicality, and volume of postoperative adjuvant therapy. All patients underwent surgery using an operating microscope. Control of resection radicality was assessed based on contrast-enhanced MRI data performed within 24 hours after surgery. Remote treatment results were assessed based on overall and relapse-free survival data, taking into account stratification by MGMT promoter status as a predictive biomarker of response to adjuvant therapy. Results. The GTR97 % index in the fluorescent surgery group was 91.70 %, while in the control group it was only 60 %. The median free-progression survival in the fluorescence-guided surgery group was 10.1±1.1 months, in the control group (with white light surgery, without fluorescence-guided surgery) was 6.3±1.3 months (p=0.049). The median overall survival in the fluorescence-guided surgery group was 19.2±1.5 months, in the control group (with white light surgery, without fluorescence-guided surgery) was 13.6±1.4 months (p=0.075). The MGMT promoter status in patients was the main predictive independent prognostic factor (p>0.05), influencing the median overall and recurrence-free survival in both groups. The median overall survival in patients with a methylated MGMT promoter (MGMT+) in the fluorescent surgery group was 25.3±1.3 months, in the control group (with white light surgery, without fluorescent surgery) 16.8±1.1 months (p=0.068). For patients with an unmethylated MGMT promoter (MGMT-), the median overall survival in the fluorescent surgery group was 17.1±1.4 months, in the control group 11.0±1.9 months (p=0.083). Conclusion. Fluorescence-guided surgery not only increases the radicality of the surgical intervention, ensuring more accurate detection of the tumor and its resection, but also increases the median overall and relapse-free survival in patients with glioblastoma.