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Predicting the "usefulness" of 5-ALA-derived tumor fluorescence for fluorescence-guided resections in pediatric brain tumors: a European survey.

Stummer W, Rodrigues F, Schucht P, Preuss M, Wiewrodt D, Nestler U, Stein M, Artero JM, Platania N, Skjøth-Rasmussen J, Della Puppa A, Caird J, Cortnum S, Eljamel S, Ewald C, González-García L, Martin AJ, Melada A, Peraud A, Brentrup A, Santarius T, Steiner HH, European ALA Pediatric Brain Tumor Study Gro - Acta Neurochir (Wien) (2014)

Bottom Line: Fluorescence was found useful in 12 of 14 glioblastomas (85 %), four of five anaplastic astrocytomas (60 %), and eight of ten ependymomas grades II and III (80 %).Fluorescence was found inconsistently useful in PNETs (three of seven; 43 %), gangliogliomas (two of five; 40 %), medulloblastomas (two of eight, 25 %) and pilocytic astrocytomas (two of 13; 15 %).These data indicate controlled studies to be necessary and also provide a basis for planning such a study.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany, walter.stummer@ukmuenster.de.

ABSTRACT

Background: Five-aminolevulinic acid (Gliolan, medac, Wedel, Germany, 5-ALA) is approved for fluorescence-guided resections of adult malignant gliomas. Case reports indicate that 5-ALA can be used for children, yet no prospective study has been conducted as of yet. As a basis for a study, we conducted a survey among certified European Gliolan users to collect data on their experiences with children.

Methods: Information on patient characteristics, MRI characteristics of tumors, histology, fluorescence qualities, and outcomes were requested. Surgeons were further asked to indicate whether fluorescence was "useful", i.e., leading to changes in surgical strategy or identification of residual tumor. Recursive partitioning analysis (RPA) was used for defining cohorts with high or low likelihoods for useful fluorescence.

Results: Data on 78 patients <18 years of age were submitted by 20 centers. Fluorescence was found useful in 12 of 14 glioblastomas (85 %), four of five anaplastic astrocytomas (60 %), and eight of ten ependymomas grades II and III (80 %). Fluorescence was found inconsistently useful in PNETs (three of seven; 43 %), gangliogliomas (two of five; 40 %), medulloblastomas (two of eight, 25 %) and pilocytic astrocytomas (two of 13; 15 %). RPA of pre-operative factors showed tumors with supratentorial location, strong contrast enhancement and first operation to have a likelihood of useful fluorescence of 64.3 %, as opposed to infratentorial tumors with first surgery (23.1 %).

Conclusions: Our survey demonstrates 5-ALA as being used in pediatric brain tumors. 5-ALA may be especially useful for contrast-enhancing supratentorial tumors. These data indicate controlled studies to be necessary and also provide a basis for planning such a study.

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Distribution of administration time of complete cohort, stratified by recurrence status
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Fig2: Distribution of administration time of complete cohort, stratified by recurrence status

Mentions: All children were given 20 mg/kg Gliolan orally dissolved in tap water. However, there was a wide variation in timing of application of 5-ALA solution prior to surgery, as detailed in Fig. 2. Solutions were generally administered between 2 and 4 h prior to surgery. A distinct group of children was given solution at 6 h prior to surgery.Fig. 2


Predicting the "usefulness" of 5-ALA-derived tumor fluorescence for fluorescence-guided resections in pediatric brain tumors: a European survey.

Stummer W, Rodrigues F, Schucht P, Preuss M, Wiewrodt D, Nestler U, Stein M, Artero JM, Platania N, Skjøth-Rasmussen J, Della Puppa A, Caird J, Cortnum S, Eljamel S, Ewald C, González-García L, Martin AJ, Melada A, Peraud A, Brentrup A, Santarius T, Steiner HH, European ALA Pediatric Brain Tumor Study Gro - Acta Neurochir (Wien) (2014)

Distribution of administration time of complete cohort, stratified by recurrence status
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4232748&req=5

Fig2: Distribution of administration time of complete cohort, stratified by recurrence status
Mentions: All children were given 20 mg/kg Gliolan orally dissolved in tap water. However, there was a wide variation in timing of application of 5-ALA solution prior to surgery, as detailed in Fig. 2. Solutions were generally administered between 2 and 4 h prior to surgery. A distinct group of children was given solution at 6 h prior to surgery.Fig. 2

Bottom Line: Fluorescence was found useful in 12 of 14 glioblastomas (85 %), four of five anaplastic astrocytomas (60 %), and eight of ten ependymomas grades II and III (80 %).Fluorescence was found inconsistently useful in PNETs (three of seven; 43 %), gangliogliomas (two of five; 40 %), medulloblastomas (two of eight, 25 %) and pilocytic astrocytomas (two of 13; 15 %).These data indicate controlled studies to be necessary and also provide a basis for planning such a study.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany, walter.stummer@ukmuenster.de.

ABSTRACT

Background: Five-aminolevulinic acid (Gliolan, medac, Wedel, Germany, 5-ALA) is approved for fluorescence-guided resections of adult malignant gliomas. Case reports indicate that 5-ALA can be used for children, yet no prospective study has been conducted as of yet. As a basis for a study, we conducted a survey among certified European Gliolan users to collect data on their experiences with children.

Methods: Information on patient characteristics, MRI characteristics of tumors, histology, fluorescence qualities, and outcomes were requested. Surgeons were further asked to indicate whether fluorescence was "useful", i.e., leading to changes in surgical strategy or identification of residual tumor. Recursive partitioning analysis (RPA) was used for defining cohorts with high or low likelihoods for useful fluorescence.

Results: Data on 78 patients <18 years of age were submitted by 20 centers. Fluorescence was found useful in 12 of 14 glioblastomas (85 %), four of five anaplastic astrocytomas (60 %), and eight of ten ependymomas grades II and III (80 %). Fluorescence was found inconsistently useful in PNETs (three of seven; 43 %), gangliogliomas (two of five; 40 %), medulloblastomas (two of eight, 25 %) and pilocytic astrocytomas (two of 13; 15 %). RPA of pre-operative factors showed tumors with supratentorial location, strong contrast enhancement and first operation to have a likelihood of useful fluorescence of 64.3 %, as opposed to infratentorial tumors with first surgery (23.1 %).

Conclusions: Our survey demonstrates 5-ALA as being used in pediatric brain tumors. 5-ALA may be especially useful for contrast-enhancing supratentorial tumors. These data indicate controlled studies to be necessary and also provide a basis for planning such a study.

Show MeSH
Related in: MedlinePlus