NICE has published a new guideline on the diagnosis, monitoring, and management of primary brain tumour or brain metastases in people aged 16 or over. The guideline includes recommendations on the investigations and management of suspected glioma, meningioma, and brain metastases, as well as follow-up and supportive care, neurorehabilitation, and surveillance for late-onset side effects of treatment.
After a long-fought campaign by charities and doctors, NICE now recommends 5‑aminolevulinic acid (5‑ALA)-guided resection for radiologically-enhanced suspected high-grade glioma.
Although the decision was based on personal clinical experiences and low- or very low-quality evidence from just one randomized controlled trial which was considered to be of low- or very low-quality, the guideline development committee determined that the use of the agent was likely to lead to improved resection and greater progression-free and overall survival.
Using 5‑ALA will be associated with a high cost; 5‑ALA-guided surgery requires a non-standard fluorescence-detecting microscope. “The resource impact of this recommendation is likely to be high in all settings, and very high in settings without access to a fluorescence-detecting microscope,” the committee acknowledged. The anticipated resource impact of the recommendation is expected to be more than £1 million per year. However, the use of the technology in even a small number of patients is expected to offset the costs.
The full guidelines are available here.