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 | ||||||
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Patient or population: high‐grade glioma Settings: specialist centres Intervention: iMRI image‐guided surgery (based on postoperative MRI) Comparison: standard surgery | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | iMRI image‐guided surgery | |||||
| Extent of resection: incomplete resection | 32a per 100 | 4 per 100 (1 to 31) | RR 0.13 (0.02 to 0.96) | 49 participants (1 study) | ⊕⊝⊝⊝b,c Verylow | Small trial of highly selected participants with potential bias in allocation and performance. 1 other trial reported this outcome but did not contribute towards the analysis. |
| Adverse events | Inadequately and inconsistently reported in the trial | ⊕⊝⊝⊝d Verylow | Adverse events were reported in an inconsistent manner and not according to the manner prespecified in our protocol. | |||
| Overall survival | Not estimable | ⊕⊝⊝⊝d Verylow | Abstract publication only in 2017. 24 (83%) of 29 patients randomly allocated to the iMRI group and 21 (72.4%) of 29 controls were eligible for analysis of overall survival, reported as "iMRI itself did not affect outcome (560 vs. 624 days, p=0.53)". Unable to identify which 8 patients had metastasis (these were excluded from published trial in 2011). | |||
| Progression‐free survival | Not estimable | ⊕⊝⊝⊝d Verylow | Progression‐free survival or time to progression was not adequately reported in the trial. | |||
| Quality of life | Not estimable | ⊕⊝⊝⊝d Verylow | Quality of life was not reported in the trial. | |||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. 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; MRI: 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. | ||||||
aExpressed in terms of risk of incomplete resection (bad outcome). bSmall trial so quality of the evidence downgraded one level. cHighly selected participants with potential bias in allocation and performance as well as in other 'Risk of bias' domains, thus downgraded two levels. dOutcome was not reported (or inadequately reported for meaningful conclusions to be drawn), therefore giving lowest quality of evidence judgement.