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Journal of Environmental Pathology, Toxicology and Oncology
Impact-faktor: 1.15 5-jähriger Impact-Faktor: 1.4 SJR: 0.519 SNIP: 0.613 CiteScore™: 1.61

ISSN Druckformat: 0731-8898
ISSN Online: 2162-6537

Journal of Environmental Pathology, Toxicology and Oncology

DOI: 10.1615/JEnvironPatholToxicolOncol.v26.i2.110
pages 157-164

ALA and Malignant Glioma: Fluorescence-Guided Resection and Photodynamic Treatment

Herbert Stepp
Laser-Forschungslabor, LIFE-Center, University Clinic Munich—Großhadern, Marchioninistr. 23, 81377 Munich, Germany
Tobias Beck
Laser-Forschungslabor, LIFE-Center, University Clinic Munich—Großhadern, Marchioninistr. 23, 81377 Munich, Germany
Thomas Pongratz
Laser-Forschungslabor, LIFE-Center, University Clinic Munich—Großhadern, Marchioninistr. 23, 81377 Munich, Germany
Thomas Meinel
Clinstud, Clinical Research Institute Hamburg, Beim Alten Gaswerk 1, 22761 Hamburg, and Institut für Neuroradiologie, Klinikum der J.-W. Goethe Universität Frankfurt, Germany
Friedrich-Wilhelm Kreth
Dept. of Neurosurgery, University Clinic Munich—Großhadern, Marchioninistr. 15, 81377 Munich, Germany
Jorg Ch. Tonn
Dept. of Neurosurgery, University Clinic Munich—Großhadern, Marchioninistr. 15, 81377 Munich, Germany
Walter Stummer
Department of Neurosurgery, University Clinic Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany

ABSTRAKT

Background: Oral application of 20 mg/kg body weight of 5-aminolevulinic acid (ALA) leads to a highly specific accumulation of fluorescent Protoporphyrin IX (PPIX) in malignant glioma tissue. In the past few years, we have participated in several clinical studies designed to investigate fluorescence guided resection (FGR) and photodynamic therapy (PDT). Methods: PPIX selectivity and PPIX bleaching during PDT were assessed with spectroscopic measurements. FGR was performed in 18 clinics in Germany (ALA-Glioma Study Group, participants see end of paper) in a phase III trial comprising an ALA group and a white-light group. PDT was performed with microlens fibers or cylindrical diffusers postsurgically to the resection bed. Additionally, a protocol for the interstitial stereotactic placement of cylindrical diffusers was established and applied on patients with recurrent, inoperable glioblastoma. Results: Compared to normal cortex, mean PPIX fluorescence in vital tumor was found more than 100-fold increased. During PDT, the PPIX fluorescence bleached to 8%, 16%, and 1% of the initial intensity for the 100, 150, and 200 J/cm2 groups (median values). FGR: Contrast-enhancing tumor was completely resected in 65% of patients in the ALA group compared to 36% in the white-light group (p < 0.0001). Progression-free survival was superior in the ALA group compared to white-light patients with cumulative 6 months progression-free survival rates of 41% and 21% (p = 0.0003), respectively. Interstitial PDT can be performed with multiple radial diffusers approximately 10 mm apart, 200 mW/cm, and an irradiation time of one hour.


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