Artikel
Stereotactic interstitial photodynamic therapy of circumscribed malignant gliomas using 5-aminolevulinic acid (5-ALA)
Stereotaktische interstitielle photodynamische Therapie umschriebener maligner Gliome mit 5-Aminolaevulinsäure (5-ALA)
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Autoren
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J. H. Mehrkens
- Neurochirurgische Universitätsklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München
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W. Stummer
- Neurochirurgische Universitätsklinik, Heinrich-Heine-Universität Düsseldorf
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T. Beck
- Laserforschungs Labor, Klinikum Großhadern, Ludwig-Maximilians-Universität München
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J.-C. Tonn
- Neurochirurgische Universitätsklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München
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F. W. Kreth
- Neurochirurgische Universitätsklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
Photodynamic therapy (PDT) might have the potential to improve local tumour control in selected patients: In PDT a photosensitiser (PS) is transferred selectively in tumour cells and activated by light of an appropriate wave length leading to cytotoxic reactions. However, uncertainties concerning dosimetry and PS-distribution as well as therapy-related side-effects have limited the clinical impact of PDT. These disadvantages might be overcome by the concept of stereotactic interstitial PDT (iPDT) using 5-ALA as PS.
Methods
iPDT was considered to be indicated for patients with a minimum Karnofsky Performance Status (KPS) of 70 with a “circumscribed” recurrence of a malignant glioma after prior multimodal therapy with a maximum diameter of 3 cm. All operations were performed under general anesthesia. Patients received 20mg/Kg 5-ALA 1 h pre-operatively. After tumour histology had been verified by stereotactic serial biopsy, 3D-multimodal-treatment planning (CT, MRT, FET-PET) followed by stereotactic implantation of up to 6 laser-probes was performed. Irradiation time was 60 min (Ceralas PDT Diode Laser: wavelength 633nm, power 200mW/cm (biolitec AG, Jena, Germany)). Follow-up MRI was performed at 24 h, 4 weeks and than in 3 month-intervals post-operatively.
Results
Between October 2002 and December 2003 10 adult patients (mean age 54, range 31-72 years, mean tumour volume 7.9 ml, range 2.1-26ml) were included. The applied volume-dose was in the range of 1000 - 1500 J/cm3. Early MRI follow-up showed a complete resolution of the contrast-enhanced lesion in 7 patients and a partial response in the other 3. There was no enhanced treatment-induced brain edema. There was no surgery or treatment related morbidity or mortality. The estimated 1-year-survival rate was 70% (3 patients had died on last follow-up).
Conclusions
Stereotactic iPDT using 5-ALA is a minimal invasive and low-risk therapy. The multimodal 3-D treatment planning for the first time allows an exact three-dimensional dosimetry and irradiation of a defined tumor volume.
