To what extent will 5-aminolevulinic acid change the face of malignant glioma surgery?

Valle, Ricardo Díez; Solís, Sonia Tejada

doi:10.2217/cns.15.10

Cited by 10 publications

(5 citation statements)

References 52 publications

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“…Other studies validated these results; Díez et al achieved complete resection of contrast-enhancing volume in 83.3% of 36 patients affected by GBM [ 15 , 25 ]. Similarly, in the retrospective studies of Schucht et al and Della Puppa et al always 5-ALA allowed with high gross total resection (GTR) rates [ 26 , 27 , 28 ].…”

Section: Resultsmentioning

confidence: 68%

“…Malignant glioma cells have the capacity to selectively synthesize or accumulate 5-ALA-derived porphyrins after exogenous administration of 5-ALA. To use fluorescence-guided surgery, the surgical microscope is provided by a xenon light source; this permit to switch between white bright and the violet-blue light (370–440 nm) needed to excite PpIX [ 15 ]. In order to visualize the tumor as a red fluorescent mass (emission peaks between 635 and 704 nm), a proper filter is added to the microscope lens [ 13 , 16 ].…”

Section: Resultsmentioning

confidence: 99%

“…Solid tumor was definitively identified by solid fluorescence whit 100% positive predictive value (PPV). Vague fluorescence identified the invaded tissue beyond the tumor mass with 97% positive predictive value and 66% negative predictive value (NPV) [ 15 ].…”

Section: Resultsmentioning

confidence: 99%

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With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas

Maugeri¹,

Villa²,

Pino³

et al. 2018

Brain Sciences

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High-grade gliomas (HGGs) are the most frequent primary malignant brain tumors in adults, which lead to death within two years of diagnosis. Maximal safe resection of malignant gliomas as the first step of multimodal therapy is an accepted goal in malignant glioma surgery. Gross total resection has an important role in improving overall survival (OS) and progression-free survival (PFS), but identification of tumor borders is particularly difficult in HGGS. For this reason, imaging adjuncts, such as 5-aminolevulinic acid (5-ALA) or fluorescein sodium (FS) have been proposed as superior strategies for better defining the limits of surgical resection for HGG. 5-aminolevulinic acid (5-ALA) is implicated as precursor in the synthetic pathway of heme group. Protoporphyrin IX (PpIX) is an intermediate compound of heme metabolism, which produces fluorescence when excited by appropriate light wavelength. Malignant glioma cells have the capacity to selectively synthesize or accumulate 5-ALA-derived porphyrins after exogenous administration of 5-ALA. Fluorescein sodium (FS), on the other hand, is a fluorescent substance that is not specific to tumor cells but actually it is a marker for compromised blood-brain barrier (BBB) areas. Its effectiveness is confirmed by multicenter phase-II trial (FLUOGLIO) but lack of randomized phase III trial data. We conducted an analytic review of the literature with the objective of identifying the usefulness of 5-ALA and FS in HGG surgery in adult patients.

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Section: Resultsmentioning

confidence: 68%

Section: Resultsmentioning

confidence: 99%

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With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas

Maugeri¹,

Villa²,

Pino³

et al. 2018

Brain Sciences

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“…The uorescence intensity is extremely variable in tumor samples, as reported previously [9,26,31,36,37]. Fluorescence intensity has been associated with increased malignancy[16, 30,31] and depends on the intrinsic [8,16,17,19,31,32,38] and environmental properties of the tumor [14,22].…”

Section: Introductionmentioning

confidence: 68%

Molecular Characteristic of High Grade Glioma in Relation to 5-ala Fluorescence Intensity

Arjona,

Almunia,

Valentí

et al. 2024

Preprint

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The intensity of 5-ALA fluorescence used in glioma surgery varies within tumors, and among different patients, several molecular and external factors have been implicated; however, there is no clear evidence analysing the difference in fluorescence according to glioma molecular characteristics. This study aimed to compare the molecular factors of glioma samples with fluorescence intensity to identify potential cofounders and associations with clinically relevant tumor features. Tumor samples from high-grade glioma patients treated with 5-ALA for guided resection were included for comparative analysis of fluorescence intensity and molecular features. The mean fluorescence was compared for each molecular variation. p53, ATRX and Ki67 expression and IDH1 mutation status were assessed via immunohistochemistry. The patients were followed upfor progression-free survival and overall survival. We found that the fluorescence intensity for each specific tumor was independent of the methylation status of the MGMT promoter region, as assessed by pyrosequencing, and that there was no association between fluorescence and p53, ATRX, or IDH1 mutation, as assessed by immunochemistry. Additionally, fluorescence intensity was not related to the duration of tumor recurrence or overall survival. Weargue that many factors are involved in the difference in fluorescence intensity and may be related to the specific metabolic status of the glioma cells analysed, which is likely responsible for the variation in fluorescence.

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“…Using 5-ALA, the tumor is clearly visible in the surgical field; therefore, the only reason to leave tumor tissue behind should be that the tumor affects an eloquent area of the brain or areas whose lesion could produce a neurological deficit for the patient [26].…”

Section: Discussionmentioning

confidence: 99%

Recent Advances in the Treatment of Gliomas: The Multimodal Care Therapy

Ibrahim

Hafez

Haleem

et al. 2021

Open Access Maced J Med Sci

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BACKGROUND: Glioblastoma (GBM) is the most devastating primary malignancy of the central nervous system in adults. At present, standard treatment consists of maximal safe surgical resection followed by radiotherapy (60 Gray) with concomitant daily temozolomide chemotherapy. Low-grade gliomas constitute approximately 15% of the nearly primary brain tumors diagnosed in adults each year. Extent of tumor resection has become a strong predictor of patient outcomes, alongside patient age, performance status, tumor histology, and molecular genetics (isocitrate dehydrogenase-1 and 1p/19q codeletion status). Over the past two decades, surgeons have emphasized the importance of maximizing extent of resection and its impact on overall survival, progression-free survival, and time to malignant transformation. AIM: We aimed to present recent advances in the treatment of gliomas. METHODS: This is a prospective analysis of 50 patients diagnosed with gliomas which are enrolled in a joint supervision between Kasr Al Aini Hospital, Cairo University, Egypt, and Coventry University Hospitals, England. RESULTS: The study included 50 patients, 31 males and 19 females, ages ranged from 21 to 75 years (mean age 47.5 years). Gross total resection was achieved in 28 patients (56%). The most common surgical complication in our series was post-operative transient weakness in 4 patients (8%). Mean true survival of low-grade glioma patients was 40.5 months while the mean true survival for anaplastic astrocytoma (Grade 3) patients was 38 months and that of GBM (Grade 4) patients was 18.8 months. CONCLUSION: Despite persistent limitations in the quality of data, mounting evidence suggests that more extensive surgical resection is associated with longer life expectancy for both low- and high-grade gliomas.

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To what extent will 5-aminolevulinic acid change the face of malignant glioma surgery?

Cited by 10 publications

References 52 publications

With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas

With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas

Molecular Characteristic of High Grade Glioma in Relation to 5-ala Fluorescence Intensity

Recent Advances in the Treatment of Gliomas: The Multimodal Care Therapy

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