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@ARTICLE{Roder:276944,
      author       = {C. Roder and W. Stummer and J. Coburger and M. Scherer and
                      P. Haas and C. von der Brelie and M. A. Kamp and M. Löhr
                      and C. A. Hamisch and M. Skardelly and T. Scholz and S.
                      Schipmann and J. Rathert and C. M. Brand and A. Pala and U.
                      Ernemann and F. Stockhammer and R. Gerlach and P. Kremer and
                      R. Goldbrunner and R.-I. Ernestus and M. Sabel and V. Rohde
                      and G. Tabatabai$^*$ and P. Martus and S. Bisdas and O.
                      Ganslandt and A. Unterberg and C. R. Wirtz and M. Tatagiba},
      title        = {{I}ntraoperative {MRI}-{G}uided {R}esection {I}s {N}ot
                      {S}uperior to 5-{A}minolevulinic {A}cid {G}uidance in
                      {N}ewly {D}iagnosed {G}lioblastoma: {A} {P}rospective
                      {C}ontrolled {M}ulticenter {C}linical {T}rial.},
      journal      = {Journal of clinical oncology},
      volume       = {41},
      number       = {36},
      issn         = {0732-183X},
      address      = {Alexandria, Va.},
      publisher    = {American Society of Clinical Oncology},
      reportid     = {DKFZ-2023-01221},
      pages        = {5512-5523},
      year         = {2023},
      note         = {2023 Dec 20;41(36):5512-5523},
      abstract     = {Prospective 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.This 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.We 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 (P =
                      .79). Incision-suture times (P < .001) were significantly
                      longer in the iMRI arm (316 v 215 [5-ALA] minutes). Median
                      PFS and OS were comparable in both arms. The lack of any
                      residual contrast enhancing tumor (0 cm³) was a significant
                      favorable prognostic factor for PFS (P < .001) and OS (P =
                      .048), especially in methylguanine-DNA-methyltransferase
                      unmethylated tumors (P = .006).We 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.},
      cin          = {TU01},
      ddc          = {610},
      cid          = {I:(DE-He78)TU01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37335962},
      doi          = {10.1200/JCO.22.01862},
      url          = {https://inrepo02.dkfz.de/record/276944},
}