Article
Imact of the use of 5-ALA on overall survival in patients undergoing surgery for metastatic brain disease – a matched cohort study
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Published: | June 9, 2017 |
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Objective: Recent studies suggested a reduced incidence of local recurrence after supramarginal resection of brain metastases employing either 5-aminolaevulinic acid (ALA) fluorescence or an additional 5mm margin in non-eloquent regions. We analyzed whether overall survival differed after resection of metastases with or without the use of 5-ALA.
Methods: We included consecutive patients who underwent surgical resection of brain metastases at our institution since June 2013 up until 11/2015 in the present analysis. A minimum follow-up of 1 year was required for inclusion in this study. We routinely employ 5-ALA in the resection of brain metastases as part of the prospective Metastasys-trial-protocol. Age- and sex-matched cohorts were extracted for analysis of overall survival after resection with and without 5-ALA.
Results: A total of 125 patients were included in the present analysis (50% male, mean age 63yrs (CI95%: 45-79yrs)). The primary tumor originated from the lung in 57 cases (47%) in the conventional and in 25 cases (52%) in the 5-ALA-group (p>0.05). N=89 patients were operated without addition of 5-ALA fluorescence, while 36 patients underwent fluorescence-assisted tumor resection. Overall survival was 35.5 (26-45) weeks in the conventional group and 28.8 (21-35) weeks in the 5-ALA group. Kaplan-Meier Log rank testing revealed no difference between groups (p=0.39).
Conclusion: This matched cohort study revealed no significant difference in overall survival between patients operated with and without the use of 5-ALA. Despite cohort matching, differences in the extracerebral burden which were not taken into account may explain the discrepancy between our findings and previous reports.