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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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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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  • Abdelhalim Hussein - Göttingen, Deutschland
  • Ingo Fiss - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Christina Wolfert - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Silvia Hernandez-Duran - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Annalen Bleckmann - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Bawarjan Schatlo - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.23.04

doi: 10.3205/17dgnc139, urn:nbn:de:0183-17dgnc1393

Published: June 9, 2017

© 2017 Hussein 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

Text

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.