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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Stereotactic interstitial photodynamic treatment of glioblastoma recurrences

Stereotaktische interstitielle photodynamische Behandlung von Glioblastomrezidiven

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  • presenting/speaker Stefanie Lietke - Klinikum der Ludwig-Maximilians-Universität München, Abteilung für Neurochirurgie, München, Deutschland
  • Michael Schmutzer - Klinikum der Ludwig-Maximilians-Universität München, Abteilung für Neurochirurgie, München, Deutschland
  • Adrian Rühm - Klinikum der Ludwig-Maximilians-Universität München, Medizinische Klinik IV Endokrinologie, München, Deutschland; Klinikum der Ludwig-Maximilians-Universität München, Abteilung für Urologie, München, Deutschland
  • Christian Heckl - Klinikum der Ludwig-Maximilians-Universität München, Medizinische Klinik IV Endokrinologie, München, Deutschland; Klinikum der Ludwig-Maximilians-Universität München, Abteilung für Urologie, München, Deutschland
  • Maximilian Aumiller - Klinikum der Ludwig-Maximilians-Universität München, Medizinische Klinik IV Endokrinologie, München, Deutschland; Klinikum der Ludwig-Maximilians-Universität München, Abteilung für Urologie, München, Deutschland
  • Ronald Sroka - Klinikum der Ludwig-Maximilians-Universität München, Medizinische Klinik IV Endokrinologie, München, Deutschland; Klinikum der Ludwig-Maximilians-Universität München, Abteilung für Urologie, München, Deutschland
  • Friedrich-Wilhelm Kreth - Klinikum der Ludwig-Maximilians-Universität München, Abteilung für Neurochirurgie, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV085

doi: 10.3205/20dgnc088, urn:nbn:de:0183-20dgnc0882

Published: June 26, 2020

© 2020 Lietke 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: Stereotactic interstitial photodynamic therapy (iPDT) using 5-aminolevulinic acid (5-ALA) induced protoporphyrin IX (PPIX) as a selectively working photosensitizer has been shown to be a feasible treatment option for selected small sized unresectable glioblastoma recurrences. We here present for the first time outcome measurements and the risk profile of salvage iPDT of a large and consecutively treated study cohort. The study was approved by the institutional ethical board.

Methods: From our prospective data base we identified all patients undergoing iPDT of a glioblastoma recurrence after previously performed standard treatment. Patients had to have biopsy-proven glioblastoma recurrences with a maximum diameter of 3 cm not suitable for safe complete resection. Treatment decision in favor of iPDT was an interdisciplinary consensus. A modified 3-D treatment-planning software was used to calculate both the treatment volume and the exact position of the light diffusers within the lesion to ensure complete light irradiation. We estimated time-to-treatment-failure (which had to be proven by biopsy) and post-recurrence survival (PRS) and the risk profile of iPDT. Prognostic factors were obtained from logistic regression models.

Results: A total of 59 patients (median age: 48.5 yrs) were included. A median number of 4 laser fibers were steretoctically implanted. Median irradiation time was one hour. Median time-to-treatment-failure was 6.53 months and median PRS was 12.50 months. The 2- and 5-year PRS rates were 22.0 and 6.1%, respectively. 24 patients developed transient peri-operative complications. There was no permanent morbidity. Neither molecuar, patient- nor treatment-related markers impacted treatment response.

Conclusion: Outcome after iPDT is heterogeneous and cannot currently be predicted. The procedure deserves further prospective evaluation particularly with respect to assumed favorable impact on adapted immunity in selected patients.