gms | German Medical Science

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

Fluorescence real-time kinetics of protoporphyrin IX after 5-ALA administration and factors predicting fluorescence in low-grade glioma

Echtzeit-Fluoreszenzkinetik von Protoporphyrin IX nach 5-ALA-Gabe und Faktoren, die die Fluoreszenz bei geringgradigem Gliom vorhersagen

Meeting Abstract

  • presenting/speaker Eric Suero Molina - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
  • Sadahiro Kaneko - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland; Hokkaido University Graduate School of Medicine, Department of Neurosurgery, Sapporo, Japan
  • Peter B. Sporns - Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Deutschland
  • Stephanie Schipmann-Miletic - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
  • David Black - University of British Columbia, Vancouver, Canada
  • Walter Stummer - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, 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. DocV197

doi: 10.3205/20dgnc193, urn:nbn:de:0183-20dgnc1936

Published: June 26, 2020

© 2020 Suero Molina 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: Five-Aminolevulinic acid (5-ALA) has been established as a compound for inducing fluorescence and assisting resection in high-grade glioma. However, in low-grade glioma (LGG) the clinical value of 5-ALA-induced fluorescence is unclear. Particularly, time-dependency and time kinetics have not been yet investigated. The purpose of this study was to investigate real-time kinetics of Protoporphyrin IX (PpIX) in LGG based on hyperspectral fluorescence-based measurements.

Methods: We evaluated patients harboring LGG surgically treated. Patients received 5-ALA at a standard dose of 20 mg/kg b.w. 4 hours prior to surgery. Assessments were performed utilizing a hyperspectral camera. Fluorescence intensity (FI) and PpIX concentration (CPpIX) were measured in the tumor tissue. We furthermore evaluated apparent diffusion coefficient (ADC)-based tumor cell density, Ki-67/MIB-1 Index, chromosomal 1p/19q co-deletion and18F-fluoro-ethyl-tyrosine (18F-FET)-PET values and their role for predicting fluorescence.

Results: 81 tissues from 25 LGG patients were included in this study. Tissues with fluorescence delivered a maximum of FI and CPpIX between 7-8 hours after 5-ALA administration. When visible fluorescence was available, peaks of FI and CPpIX were observed within a 7-8 hour time-frame regardless of MRI contrast-enhancement. GD-enhancement (p=0.008), Ki-67/MIB-1 Index (p<0.001),18F-FET-PET uptake ratio (p=0.038) and ADC-based tumor cellularity (p=0.017) differed significantly between fluorescing- and non-fluorescing tissue. 1p/19q co-deletion was not reliable for predicting fluorescence. Logistic regression demonstrated18F-FET-PET uptake and Ki-67/MIB-1 Index as independent variables for predicting fluorescence.

Conclusion: We report in a fluorescence-based assessment of CPpIX in human LGG tissues.18F-FET-PET uptake and Ki-67/MIB-1 are independent strong factors for predicting fluorescence. Similar to previously reported in HGG, fluorescence peaked between 7-8 hours after 5-ALA application. In consequence, 5-ALA administration in patients with suspected LGG should be 4-5 hours prior to surgery and always adapted to the clinic’s own logistics environment.