gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

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)

Meeting Abstract

  • corresponding author J. H. Mehrkens - Neurochirurgische Universitätsklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • W. Stummer - Neurochirurgische Universitätsklinik, Heinrich-Heine-Universität Düsseldorf
  • T. Beck - Laserforschungs Labor, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • J.-C. Tonn - Neurochirurgische Universitätsklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • F. W. Kreth - Neurochirurgische Universitätsklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc11.05.-05.05

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0190.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Mehrkens et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


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.