Glioblastoma multiforme treatment with clinical trials for surgical resection (aminolevulinic acid)

Abstract

5-Aminolevulinic acid (5-ALA)-induced tumor fluorescence can be used to identify tissue for resection using an adapted operating microscope. A multi-institutional clinical trial comparing fluorescence-guided versus white light tumor resection reported significant improvement in completeness of resection and 6-month progression-free survival. The degree of 5-ALA-induced fluorescence correlates with histopathologic grade of tumor, degree of tumor cell infiltration, and proliferation indices. Quantitative methodologies for assessment of tissue fluorescence have significantly improved the ability to detect tumor tissue and intraoperative diagnostic performance. These developments extend the applicability of this technology to additional tumor histologies and provide the rationale for further instrumentation development.

Copyright © 2012 Elsevier Inc. All rights reserved.

Figures

Fig. 1

(A) White-light operating microscope image at partial resection of this left parietal GBM tumor in a 79-year-old man. (B) Blue-violet light image of the same operative field. (C) Image guidance monitor image showing location of the focal point of the operating microscope at corresponding time during the procedure.

Fig. 2

(A) White-light operating microscope image at partial resection of this right temporal GBM tumor in a 68-year-old man. (B) Blue-violet light image of the same operative field. (C) Image guidance monitor image showing location of the focal point of the operating microscope at corresponding time during the procedure.

Fig. 3

(A) White-light operating microscope image at late stage of resection of a left temporal lobe GBM in a 73-year-old man. (B) Blue-violet light image corresponding to (A). (C) Handheld quantitative fluorescence probe acquiring data. (D) Raw and modeled data from probe acquisition, showing a quantitative level of the fluoro-phore PpIX that indicates tumor.