Tecnología de imagenología intraoperatoria para maximizar el grado de resección del glioma
Información
- DOI:
- https://doi.org/10.1002/14651858.CD012788.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 22 enero 2018see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Cáncer ginecológico, neurooncología y otros cánceres
- Copyright:
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- Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Citado por:
Autores
Contributions of authors
Damiano G Barone and Michael G Hart conceptualised the review and wrote the original protocol and the review. Michael D Jenkinson and Colin Watts provided senior clinical commentary. Andrew Bryant and Theresa Lawrie provided expert methodological and statistical commentary. Luke Vale provided the brief economic commentary. Helen Bulbeck contributed to the writing of the review.
Sources of support
Internal sources
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None, Other
External sources
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NIHR SRPG Project: 16/114/18, UK
Declarations of interest
Michael Jenkinson: no conflict of interest related to this review.
Damiano Barone: no conflict of interest related to this review.
Andrew Bryant: no conflict of interest related to this review.
Luke Vale: no conflict of interest related to this review.
Helen Bulbeck: no conflict of interest related to this review.
Theresa Lawrie: no conflict of interest related to this review.
Michael Hart: no conflict of interest related to this review.
Colin Watts: no conflict of interest related to this review.
Acknowledgements
We would like to thank Robin Grant (Co‐ordinating Editor), Gail Quinn, Clare Jess (Managing Editors), and Tracey Harrison (Assistant Managing Editor), for the Cochrane Gynaecological, Neuro‐oncology, and Orphan Cancer Group, for providing editorial support, as well as Jo Platt, Information Specialist, for devising the MEDLINE search strategy. We would also like to thank Ian Shemilt, EPPI‐Centre, UCL, and Luke Vale, Institute of Health & Society, Newcastle University, for support provided in development of economic search strategies and associated methods.
This project was supported by the National Institute for Health Research (NIHR), via Cochrane Programme Grant funding (SRPG Project: 16/114/18), to the Cochrane Gynaecological, Neuro‐oncology, and Orphan Cancer Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, the NHS, or the Department of Health.
Version history
| Published | Title | Stage | Authors | Version |
| 2018 Jan 22 | Intraoperative imaging technology to maximise extent of resection for glioma | Review | Michael D Jenkinson, Damiano Giuseppe Barone, Andrew Bryant, Luke Vale, Helen Bulbeck, Theresa A Lawrie, Michael G Hart, Colin Watts | |
| 2017 Sep 04 | Intraoperative imaging technology to maximise extent of resection for glioma | Protocol | Michael D Jenkinson, Damiano Giuseppe Barone, Michael G Hart, Andrew Bryant, Theresa A Lawrie, Colin Watts | |
Differences between protocol and review
There were no differences between the protocol and review.
Notes
This review has been superseded as an NMA: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013630.pub2/full
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Humans;
PICO
Study flow diagram.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
| iMRI image‐guided surgery compared to standard surgery for high‐grade glioma | ||||||
| Patient or population: high‐grade glioma | ||||||
| Outcomes | Illustrative comparative risk* (95% CI) | Relative effect | No. of participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Control | Image‐guided surgery | |||||
| Extent of resection: complete resection | 321 per 100 | 4 per 100 | RR 0.13 (0.02 to 0.96) | 49 participants | ⊕⊝⊝⊝1,2,3 | Small trial of highly selected participants with potential bias in allocation and performance. One other trial reported this outcome but did not contribute towards the analysis. |
| Adverse events | Inadequately and inconsistently reported in the trial | ⊕⊝⊝⊝4 | Adverse events were reported in an inconsistent manner and not according to the manner prespecified in our protocol. Additionally, we were mainly interested in identifying serious adverse events, which were inadequately reported | |||
| Overall survival | Not estimable | ⊕⊝⊝⊝4 | Not reported by trial authors so graded as very low quality evidence | |||
| Progression‐free survival | Not estimable | ⊕⊝⊝⊝4 | Progression‐free survival or time to progression was not adequately reported in the trial | |||
| Quality of life | Not estimable | ⊕⊝⊝⊝4 | Quality of life was not reported in the trial | |||
| *The basis for the assumed risk is only based on individual trials as only single trial reports were available. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Expressed in terms of risk of incomplete resection (bad outcome). | ||||||
| 5‐ALA image‐guided surgery compared to standard surgery for high‐grade glioma | ||||||
| Patient or population: high‐grade glioma | ||||||
| Outcomes | Illustrative comparative risk* (95% CI) | Relative effect | No. of participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Control | Image‐guided surgery | |||||
| Extent of resection: complete resection | 641 per 100 | 35 per 100 | RR 0.55 (0.42 to 0.71) | 270 participants (1 study) | ⊕⊕⊝⊝2 | Highly selected participants with potential bias in allocation and performance |
| Adverse events | Inadequately and inconsistently reported in the trial | ⊕⊝⊝⊝3 | Adverse events were reported in an inconsistent manner and not according to the manner prespecified in our protocol. Additionally, we were mainly interested in identifying serious adverse events, which were inadequately reported | |||
| Overall survival | Not estimable due to reporting of HR and since just a single trial reported on this outcome we did not arbitrarily choose a snap shot in time in which to use as basis to calculate the assumed and corresponding risks as this may be misleading. | HR 0.82 (0.62 to 1.07) | 270 participants (1 study) | ⊕⊕⊝⊝2 | The overall quality of this outcome was low in this trial and was downgraded for highly selected participants with potential bias in allocation and performance | |
| Progression‐free survival | Not adequately reported in the trials | ⊕⊝⊝⊝3 | Progression‐free survival or time to progression was not adequately reported in the trial | |||
| Quality of life | Inadequately reported or not assessed at all in the included trials | ⊕⊝⊝⊝3 | Quality of life was not reported in the trial | |||
| *The basis for the assumed risk is only based on individual trials as only single trial reports were available. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Expressed in terms of risk of incomplete resection (bad outcome). | ||||||
| Neuronavigation image‐guided surgery compared to standard surgery for high‐grade glioma | ||||||
| Patient or population: high‐grade glioma | ||||||
| Outcomes | Illustrative comparative risk* (95% CI) | Relative effect | No. of participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Control | Image‐guided surgery | |||||
| Extent of resection: complete resection | Not estimable | Not estimable | Not reported | 45 participants | ⊕⊝⊝⊝1,2,4 | Small study of highly selected participants at very high risk of allocation bias.Complete resection was achieved in three participants in the control group and five participants in the neuronavigation group. However, there was significant attrition, with not all participants completing imaging, and the denominators for these figures were not stated, precluding formal analysis |
| Adverse events | Inadequately and inconsistently reported in the trial | ⊕⊝⊝⊝2 | Adverse events were reported in an inconsistent manner and not according to the manner prespecified in our protocol. Additionally, we were mainly interested in identifying serious adverse events, which were inadequately reported | |||
| Overall survival | Not estimable | ⊕⊝⊝⊝3 | Not reported by trial authors so graded as very low quality evidence | |||
| Progression‐free survival | Not estimable | ⊕⊝⊝⊝2 | Progression‐free survival or time to progression was not reported in the trial | |||
| Quality of life | Inadequately reported or not assessed at all in the included trials | ⊕⊝⊝⊝3 | Quality of life was reported in the trial but only 19 participants (8 in the neuronavigation arm and 11 in the standard surgery arm) completed questionnaires postoperatively at 3 months', constituting only 64.5% of all eligible participants, and no statistical analysis was presented | |||
| *The basis for the assumed risk is only based on individual trials as only single trial reports were available. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Small trial so quality of the evidence downgraded by one level. | ||||||
| Score | Definition |
|---|---|
| 100 | Normal, no complaints, no evidence of disease |
| 90 | Able to carry on normal activity: minor symptoms of disease |
| 80 | Normal activity with effort: some symptoms of disease |
| 70 | Cares for self: unable to carry on normal activity or active work |
| 60 | Requires occasional assistance but is able to care for needs |
| 50 | Requires considerable assistance and frequent medical care |
| 40 | Disabled: requires special care and assistance |
| 30 | Severely disabled: hospitalisation is indicated, death is not imminent |
| 20 | Very sick, hospitalisation is necessary: active treatment is necessary |
| 10 | Moribund, fatal processes are progressing rapidly |
| 0 | Dead |
| Grade | Definition |
|---|---|
| 0 | Fully active, able to carry on all pre‐disease performance without restriction |
| 1 | Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g. |
| 2 | Ambulatory and capable of all self care, but unable to carry out any work activities. Up and about more than 50% of |
| 3 | Capable of only limited self care, confined to bed or chair more than 50% of waking hours |
| 4 | Completely disabled. Cannot carry out any self care. Totally confined to bed or chair |
| 5 | Dead |
