Article
Is 5-aminolevulinic acid (5-ALA) redundant in times of intraoperative MRI?
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Authors
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Vincent Hagel
- Neurochirurgische Klinik der Universität Ulm am Bezirkskrankenhaus Günzburg
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Ralph König
- Neurochirurgische Klinik der Universität Ulm am Bezirkskrankenhaus Günzburg
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Christian Rainer Wirtz
- Neurochirurgische Klinik der Universität Ulm am Bezirkskrankenhaus Günzburg
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Jan Coburger
- Neurochirurgische Klinik der Universität Ulm am Bezirkskrankenhaus Günzburg
| Published: | June 2, 2015 |
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Outline
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Objective: The extent of resection (EoR) plays a crucial role in glioblastoma (GBM) surgery. Both for intraoperative MRI (iMRI) and for 5-aminolevulinic acid (5-ALA) a benefit to achieve a gross total resection (GTR) was shown. 5-ALA has a more sensitive depiction of the infiltration zone. Objective for this prospective study was to assess whether there is an additional benefit of 5-ALA in a combined setup with iMRI.
Method: We report the results of a prospective series of 42 surgeries for GBM between 08/2012 and 03/2014 with an intended GTR. A combined approach using iMRI and 5-ALA was performed. We compared these patients with the whole cohort so far operated using the iMRI at our center (2008-2014) with intended GTR (112 patients). Gross total resection (GTR), progression free survival (PFS), overall survival (OS), complications and new permanent neurological deficits (nPND) were evaluated. A cox regression model was used for statistics.
Results: Mean follow-up was 21 months. GTR was achieved in 86% (36/42) using iMRI and 5-ALA compared to 75% (84/112) using iMRI alone. But this difference was not statistically significant (p<0.193). nPND (12% vs. 5%) as well as the overall complication rate (31% vs. 20%) were slightly higher using 5-ALA&iMRI compared to the sole use of iMRI. Again, both differences were not significant. Complications specifically due to 5-ALA were found in 2% (one patient suffered a sunburn grade II). In a multivariate cox regression model the use of 5-ALA did not affect PFS and OS.
Conclusions: While there are proven benefits for the single use of 5-ALA as well as iMRI, there is no additional benefit of the combined use of 5-ALA and iMRI in our series. In contrary we found a slight increase of complications using the combined approach, which could be due to the relative increase of GTR in this group. Thus, without a beneficial impact and an increase of complications we stopped the prospective study at this point.
