Summary of findings 1. iMRI image‐guided surgery compared to standard surgery for high‐grade glioma.
| iMRI image‐guided surgery compared to standard surgery for high‐grade glioma | ||||||
| Patient or population: high‐grade glioma Settings: specialist centres Intervention: iMRI image‐guided surgery (based on post‐operative MRI) Comparison: standard surgery | ||||||
| Outcomes | Illustrative comparative risk* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Image‐guided surgery | |||||
| Extent of resection: complete resection | 321 per 100 | 4 per 100 (1 to 31) | RR 0.13 (0.02 to 0.96) | 49 participants (1 study) | ⊕⊝⊝⊝1,2,3 verylow | 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 verylow | 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 verylow | Not reported by trial authors so graded as very low quality evidence | |||
| Progression‐free survival | Not estimable | ⊕⊝⊝⊝4 verylow | Progression‐free survival or time to progression was not adequately reported in the trial | |||
| Quality of life | Not estimable | ⊕⊝⊝⊝4 verylow | 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). CI: confidence interval; iMRI: intraoperative magnetic resonance imaging; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1Expressed in terms of risk of incomplete resection (bad outcome). 2Small trial so quality of the evidence downgraded by one level. 3Highly selected participants with potential bias in allocation and performance as well as in other 'Risk of bias' domains, thus downgraded by two levels. 4Outcome was not reported (or inadequately reported for meaningful conclusions to be drawn), therefore giving lowest quality of evidence judgement.