Artikel
Recurrent malignant gliomas and 5-ALA fluorescence guidance: a multicentre phase II study
Suche in Medline nach
Autoren
Veröffentlicht: | 20. Mai 2009 |
---|
Gliederung
Text
Objective: To assess the feasibility of 5-Aminolevulinic acid (5ALA) fluorescence-guided resection for recurrent malignant brain tumours.
Methods: We conducted a multicentre prospective, single-arm, uncontrolled phase II study. 36 patients with recurrent glioma (WHO grade III/IV) received 5-ALA prior to surgery. The tumours were resected employing standard microsurgical techniques. Biopsies from pathological and non-pathological areas (as identified under conventional white light) were taken to determine the positive-predictive value (PPV) of 5-ALA induced tissue fluorescence in detecting tumour. PPV was calculated on a patient-based as well as on a biopsy-based basis. Follow-up of patients extended over a period of six months after study surgery.
Results: In the patient-based approach for non-pathological appearing tissue (under white light), fluorescence positively predicted tumour in 79.4% (PPV). Within areas of strong fluorescence, PPV was higher (91.7% compared to that of weak fluorescence 82.4%). On the biopsy level (157 biopsies from non-pathological appearing tissue under white light), the positive predictive value of tissue fluorescence was 93.0%. Again, within areas of strong fluorescence, PPV was higher (96.9%; 95% CI: 89.2% – 99.6%) compared to that of weak fluorescence (90.3%; 95% CI: 82.4% – 95.5%). There were no adverse events pertaining to the study drug.
Conclusions: 5-ALA fluorescence has a high predictive value for the detection of tumour in recurrent gliomas. Prior treatment modalities, such as radiation or chemotherapy do not invalidate the fluorescence guidance with 5-ALA. As in primary malignant gliomas, 5-ALA fluorescence guidance is thus an effective surgical adjunct in the surgery of recurrent malignant gliomas.