Quality standard
Quality statement 3: 5-aminolevulinic acid-guided resection
Quality statement 3: 5-aminolevulinic acid-guided resection
Quality statement
Adults with radiologically enhancing suspected high-grade gliomas that are suitable for resection of all enhancing tumour have 5‑aminolevulinic acid (5‑ALA)-guided resection.
Rationale
Neurological resection is the first treatment for many gliomas (a type of brain tumour). But it can be very difficult to remove all the tumour. Although it is not possible to cure high-grade gliomas, 5‑ALA-guided resection is more likely to result in complete or near-complete removal of the tumour and improves progression-free survival.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.
Structure
Evidence that 5‑ALA-guided resection is available for adults with radiologically enhancing suspected high-grade gliomas that are suitable for resection of all enhancing tumour.
Data source: Data can be collected from implementation plans including access to a fluorescence-detecting microscope and specialist skills to undertake 5‑ALA-guided resection.
Process
Proportion of adults with radiologically enhancing suspected high-grade gliomas that are suitable for resection of all enhancing tumour who received 5‑ALA-guided resection.
Numerator – the number in the denominator who received 5‑ALA-guided resection.
Denominator – the number of adults with radiologically enhancing suspected high-grade gliomas that are suitable for resection of all enhancing tumour.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
Outcome
a) Proportion of adults with radiologically enhancing high-grade gliomas that are suitable for resection of all enhancing tumour who underwent resection where a 95% or greater reduction in tumour volume was achieved.
Numerator – the number in the denominator who underwent resection where a 95% or greater reduction in tumour volume was achieved.
Denominator – the number of adults with radiologically enhancing high-grade gliomas that are suitable for resection of all enhancing tumour.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
b) Progression-free survival in adults with radiologically enhancing high-grade gliomas that are suitable for resection of all enhancing tumour who had 5‑ALA-guided resection.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
What the quality statement means for different audiences
Service providers (such as specialist regional centres) ensure that specialist resources, processes and pathways are in place for adults with radiologically enhancing suspected high-grade gliomas that are suitable for resection of all enhancing tumour to have 5‑ALA-guided resection.
Healthcare professionals (such as neurosurgeons) are aware of the local pathways for adults with radiologically enhancing suspected high-grade gliomas that are suitable for resection of all enhancing tumour and ensure that they receive 5‑ALA-guided resection from a specialist.
Commissioners (NHS England) commission services that have the capacity and expertise to provide 5‑ALA-guided resection to adults with radiologically enhancing suspected high-grade gliomas that are suitable for resection of all enhancing tumour.
Adults with a suspected high-grade glioma (a type of brain tumour) that is suitable for surgery to remove the tumour have an operation that ensures as much of the tumour as possible is removed.
Source guidance
Brain tumours (primary) and brain metastases in adults. NICE guideline NG99 (2018, updated 2021), recommendation 1.2.36