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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Progression-free survival (PFS) and imaging after stereotactic 5-aminolevulinic acid (ALA)-photodynamic therapy (PDT) on malignant gliomas

Meeting Abstract

  • Robert Pannewitz - Klinik für Neurochirurgie, Heinrich-Heine-Universität, Düsseldorf, Deutschland
  • Marta Wallocha - Klinik für Neurochirurgie, Heinrich-Heine-Universität, Düsseldorf, Deutschland
  • Jan Vesper - Klinik für Neurochirurgie, Heinrich-Heine-Universität, Düsseldorf, Deutschland
  • Michael Sabel - Klinik für Neurochirurgie, Heinrich-Heine-Universität, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1708

DOI: 10.3205/10dgnc179, URN: urn:nbn:de:0183-10dgnc1793

Published: September 16, 2010

© 2010 Pannewitz et al.
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Outline

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Objective: A combination of resection, followed by radiation and chemotherapy are well established treatments for high-grade gliomas. However, in almost 100% of cases the tumor recurs. Assessment of innovative treatment options is therefore required. As we know, the extent of resection, optionally guided by ALA, is important for the overall outcome. Beyond that, ALA is a well examined substance for photodynamic treatment after or even instead of surgery in several specialties.

In this study we evaluated the impact of solitary 5- ALA- supported stereotactic photodynamic therapy as a 3rd-line-treatment after repeated progression by MRI imaging results.

Methods: Treatment was performed by positioning laser diffusors using 3-dimensional irradiation planning, and a diode laser with up to 3 separated diodes.

9 retrospectively evaluated patients underwent an MRI one day preoperatively, 48 to 72 hours postoperatively and a serial follow-up MRI every three months. In another prospective group (n=5) patients underwent an additional O-(2-[F]fluoroethyl)-L-tyrosine PET preoperatively and about two weeks after the treatment. The Karnofsky-Index (KI) was determined pre- and postoperatively and as a follow-up every three months.

Results: In the retrospective group, 1 patient is currently progression-free since 27 months and another patient since 18 months. 5 patients suffered from a progression 3 months, 2 more patients 9 months after the treatment. Concerning the prospective group at this time, 1 patient showed a progression after 3 months, another patient is already showing a PFS of over 3 months since treatment.

All in all, the overall KI declined within 3 months in the retrospective group from median 88 before operation to 83 after the operation.

Conclusions: The currently available data indicates that stereotactic PDT may represent a further adjuvant therapy that is successfully extending the PFS to improve the outcome of patients with recurrent malignant gliomas. The value of this promising method has to be established by larger prospective series.