gms | German Medical Science

66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Correlation of 5-ALA induced fluorescence with contrast enhancement on MRI, pre-operative FET-PET and tumor molecular factors in grade II and III astrocytomas

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  • Mohammed Jaber - Klinik für Neurochirurgie, Westfälische-Willhelms-Universität, Münster
  • Christian Ewelt - Klinik für Neurochirurgie, Westfälische-Willhelms-Universität, Münster
  • Nils Warneke - Klinik für Neurochirurgie, Westfälische-Willhelms-Universität, Münster
  • Markus Holling - Klinik für Neurochirurgie, Westfälische-Willhelms-Universität, Münster
  • Martin Hasselblatt - Institut für Neuropathologie, Westfälische-Willhelms-Universität, Münster
  • Tarek Zoubi - Institut für klinische Radiologie, Westfälische-Willhelms-Universität, Münster
  • Walter Stummer - Klinik für Neurochirurgie, Westfälische-Willhelms-Universität, Münster

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocDI.11.08

doi: 10.3205/15dgnc150, urn:nbn:de:0183-15dgnc1508

Published: June 2, 2015

© 2015 Jaber et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Only about 20 % of LGG but most WHO III° fluoresce after 5-ALA-application. On the other hand approximately, 30% of gliomas without enhancement on the MRI are classified as WHO III°. The aim of this study was to identify ex ante factors (i. e. age, MRI enhancement, FET-PET) for predicting intraoperative fluorcescence in grade II°/III° gliomas and to determine whether fluorescence, if observed, would allow a prediction of pathohistology (II°/III°) or molecular tumor charactaristics.

Method: We analyzed all non-GBM gliomas operated on at our institution between 01/2012 and 12/2013 that had received 5-ALA for enhancement on MRI, or FET PET or positivity. Further, IDH1 mutation and MGMT promoter methylation were examined by direct sequencing and methylation-specific PCR, respectively. 1p19q co-deletion was detected by fluorescence in situ hybridization. Statistical analysis included multivariate and recursive partitioning analysis (RPA).

Results: Of 196 gliomas 101 were grade II and 95 grade III astroycatomas (29 anaplastic oligodendrogliomas or oligoastrocytoma), 66 anaplastic astrocytomas). FET-PET was performed in 143 patients and 159 patients were given 5-ALA.

From the ex ante perspective contrast-enhancement, tumor volume and a FET-PET SUV > 1,85 significantly predicted intra-operative fluorescence on RPA. Fluorescence corrlelated significantly with the WHO grade (P=0,000) and the. MIB-index (P=0,000) but not with MGMT promoter methylation (P=0.481), IDH1 mutation (P<0.101) and. 1p19q deletion (P=0.135).

Conclusions: We identified a number of ex ante factors for predicting the usefulness of 5-ALA in non-GBM glioma patients, such as age, tumor volume and FET-PET (SUV>1,85), also in tumors without contrast-enhancement. Fluorescence in astrocytoma tissue is significantly correlated to an increased MIB-Index and more frequently observed in WHO III° gliomas but not to commonly assessed molecular markers. Whether fluorescing grade II gliomas represent a subtype with a worse prognosis remains to be determined.