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Acta Neurochirurgica

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01.03.2014 | Clinical Article - Pediatrics

Fluorescence-guided surgery with 5-aminolevulinic acid for resection of brain tumors in children—a technical report

verfasst von: Thomas Beez, Sevgi Sarikaya-Seiwert, Hans-Jakob Steiger, Daniel Hänggi

Erschienen in: Acta Neurochirurgica | Ausgabe 3/2014

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Abstract

Background

5-aminolevulinic acid (5-ALA) can be used as an adjunct for the surgery of adult malignant glioma and improves the rate of gross total resection and patient survival. So far, only three casuistic reports of fluorescence-guided surgery used in children have been published. We report our pilot series of 16 pediatric brain tumors treated with 5-ALA.

Methods

Sixteen patients (mean age 9 years, range 1–16 years) received a standardized 5-ALA dose according to the published protocol after informed parental consent. The fluorescence status (positive versus negative) in correlation with histology as well as blood samples and adverse clinical symptoms were recorded.

Results

Histology revealed pilocytic astrocytoma (n = 7), classical medulloblastoma (n = 4), anaplastic astrocytoma (n = 1), glioblastoma (n = 3) and anaplastic ependymoma (n = 1). Positive fluorescence was observed in cases of anaplastic astrocytoma, glioblastoma, and medulloblastoma, respectively. Significant increases were registered for alanine aminotransferase (14.92 ± 1.106 U/l vs. 37.70 ± 3.795 U/l, P = 0.0020) and gamma glutamyl transpeptidase (12.69 ± 1.638 U/l vs. 39.29 ± 6.342 U/l, P = 0.0156), correlated with young age. No further adverse reactions were evident.

Conclusion

Positive fluorescence was observed in two high-grade gliomas and one medulloblastoma after oral administration of 5-ALA. Thus, 5-ALA appears capable of inducing fluorescence in pediatric high-grade tumors. Adverse reactions observed in children were similar to those reported for adults, although very young children might be at increased risk. Further studies are required to elucidate pharmacokinetic and pharmacodynamic properties of 5-ALA in children and to assess its prognostic role in the resection of pediatric brain tumors.

Albright AL, Wisoff JH, Zeltzer PM, Boyett JM, Rorke LB, Stanley P (1996) Effects of medulloblastoma resections on outcome in children: a report from the Children’s Cancer Group. Neurosurgery 38(2):265–271PubMedCrossRef

Alcorn J, McNamara PJ (2003) Pharmacokinetics in the newborn. Adv Drug Deliv Rev 55(5):667–686PubMedCrossRef

Chu ESM, Wong TKS, Yow CMN (2008) Photodynamic effect in medulloblastoma: downregulation of matrix metalloproteinases and human telomerase reverse transcriptase expressions. Photochem Photobiol Sci 7(1):76–83PubMedCrossRef

Coakley KJ, Huston J, Scheithauer BW, Forbes G, Kelly PJ (1995) Pilocytic astrocytomas: well-demarcated magnetic resonance appearance despite frequent infiltration histologically. Mayo Clin Proc 70(8):747–751PubMedCrossRef

Eicker S, Sarikaya-Seiwert S, Borkhardt A, Gierga K, Turowski B, Heiroth H-J, Steiger H-J, Stummer W (2011) ALA-induced porphyrin accumulation in medulloblastoma and its use for fluorescence-guided surgery. Cent Eur Neurosurg 72(2):101–103PubMedCrossRef

Eljamel MS, Goodman C, Moseley H (2008) ALA and Photofrin fluorescence-guided resection and repetitive PDT in glioblastoma multiforme: a single centre Phase III randomised controlled trial. Lasers Med Sci 23(4):361–367PubMedCrossRef

EMA (2007) Gliolan: EPAR - scientific discussion. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_Discussion/human/000744/WC500021788.pdf. Accessed 14 Apr 2013

Etminan N, Peters C, Ficnar J, Anlasik S, Bünemann E, Slotty PJ, Hänggi D, Steiger H-J, Sorg RV, Stummer W (2011) Modulation of migratory activity and invasiveness of human glioma spheroids following 5-aminolevulinic acid-based photodynamic treatment. Laboratory investigation. J Neurosurg 115(2):281–288PubMedCrossRef

Fisher PG, Tihan T, Goldthwaite PT, Wharam MD, Carson BS, Weingart JD, Repka MX, Cohen KJ, Burger PC (2008) Outcome analysis of childhood low-grade astrocytomas. Pediatr Blood Cancer 51(2):245–250PubMedCrossRef

10.

Inoue K, Karashima T, Kamada M, Shuin T, Kurabayashi A, Furihata M, Fujita H, Utsumi K, Sasaki J (2009) Regulation of 5-aminolevulinic acid-mediated protoporphyrin IX accumulation in human urothelial carcinomas. Pathobiology 76(6):303–314PubMedCrossRef

11.

Kramm CM, Wagner S, Van Gool S, Schmid H, Sträter R, Gnekow A, Rutkowski S, Wolff JEA (2006) Improved survival after gross total resection of malignant gliomas in pediatric patients from the HIT-GBM studies. Anticancer Res 26(5B):3773–3779PubMed

12.

Kubben PL, van Santbrink H, ter Laak-Poort M, Weber JW, Vles JSH, Granzen B, van Overbeeke JJ, Cornips EMJ (2012) Implementation of a mobile 0.15-T intraoperative MR system in pediatric neuro-oncological surgery: feasibility and correlation with early postoperative high-field strength MRI. Childs Nerv Syst 28(8):1171–1180PubMedCentralPubMedCrossRef

13.

Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114(2):97–109PubMedCentralPubMedCrossRef

14.

Macy ME, Birks DK, Barton VN, Chan MH, Donson AM, Kleinschmidt-Demasters BK, Bemis LT, Handler MH, Foreman NK (2012) Clinical and molecular characteristics of congenital glioblastoma. Neuro Oncol 14(7):931–941PubMedCentralPubMedCrossRef

15.

Meyers SP, Kemp SS, Tarr RW (1992) MR imaging features of medulloblastomas. AJR 158(4):859–865PubMedCrossRef

16.

Pichlmeier U, Bink A, Schackert G, Stummer W (2008) Resection and survival in glioblastoma multiforme: an RTOG recursive partitioning analysis of ALA study patients. Neuro Oncol 10(6):1025–1034PubMedCentralPubMedCrossRef

17.

Pollack IF (1999) Pediatric brain tumors. Semin Surg Oncol 16(2):73–90PubMedCrossRef

18.

Preuß M, Renner C, Krupp W, Christiansen H, Fischer L, Merkenschläger A, Kieß W, Müller W, Manzo N, Meixensberger J, Nestler U (2013) The use of 5-aminolevulinic acid fluorescence guidance in resection of pediatric brain tumors. Childs Nerv Syst 29(8):1263–1267PubMedCrossRef

19.

Qaddoumi I, Sultan I, Gajjar A (2009) Outcome and prognostic features in pediatric gliomas: a review of 6212 cases from the Surveillance, Epidemiology, and End Results database. Cancer 115(24):5761–5770PubMedCentralPubMedCrossRef

20.

Ruge JR, Liu J (2009) Use of 5-aminolevulinic acid for visualization and resection of a benign pediatric brain tumor. J Neurosurg Pediatr 4(5):484–486PubMedCrossRef

21.

Sanai N, Snyder LA, Honea NJ, Coons SW, Eschbacher JM, Smith KA, Spetzler RF (2011) Intraoperative confocal microscopy in the visualization of 5-aminolevulinic acid fluorescence in low-grade gliomas. J Neurosurg 115(4):740–748PubMedCrossRef

22.

Schucht P, Beck J, Abu-Isa J, Andereggen L, Murek M, Seidel K, Stieglitz L, Raabe A (2012) Gross total resection rates in contemporary glioblastoma surgery: results of an institutional protocol combining 5-aminolevulinic acid intraoperative fluorescence imaging and brain mapping. Neurosurgery 71(5):927–935, discussion 935–6PubMedCrossRef

23.

Senft C, Bink A, Franz K, Vatter H, Gasser T, Seifert V (2011) Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol 12(11):997–1003PubMedCrossRef

24.

Shah MN, Leonard JR, Inder G, Gao F, Geske M, Haydon DH, Omodon ME, Evans J, Morales D, Dacey RG, Smyth MD, Chicoine MR, Limbrick DD (2012) Intraoperative magnetic resonance imaging to reduce the rate of early reoperation for lesion resection in pediatric neurosurgery. J Neurosurg Pediatr 9(3):259–264PubMedCrossRef

25.

Stepp H, Beck T, Pongratz T, Meinel T, Kreth F-W, Tonn JC, Stummer W (2007) ALA and malignant glioma: fluorescence-guided resection and photodynamic treatment. J Environ Pathol Toxicol Oncol 26(2):157–164PubMedCrossRef

26.

Stokland T, Liu J-F, Ironside JW, Ellison DW, Taylor R, Robinson KJ, Picton SV, Walker DA (2010) A multivariate analysis of factors determining tumor progression in childhood low-grade glioma: a population-based cohort study (CCLG CNS9702). Neuro Oncol 12(12):1257–1268PubMedCentralPubMed

27.

Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen H-J (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7(5):392–401PubMedCrossRef

28.

Stummer W, Reulen H-J, Meinel T, Pichlmeier U, Schumacher W, Tonn JC, Rohde V, Oppel F, Turowski B, Woiciechowsky C, Franz K, Pietsch T (2008) Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery 62(3):564–576, discussion 564–76PubMedCrossRef

29.

Stummer W, Stocker S, Wagner S, Stepp H, Fritsch C, Goetz C, Goetz AE, Kiefmann R, Reulen HJ (1998) Intraoperative detection of malignant gliomas by 5-aminolevulinic acid-induced porphyrin fluorescence. Neurosurgery 42(3):518–525, discussion 525–6PubMedCrossRef

30.

Stummer W, Tonn J-C, Mehdorn HM, Nestler U, Franz K, Goetz C, Bink A, Pichlmeier U (2011) Counterbalancing risks and gains from extended resections in malignant glioma surgery: a supplemental analysis from the randomized 5-aminolevulinic acid glioma resection study. Clinical article. J Neurosurg 114(3):613–623PubMedCrossRef

31.

Teng L, Nakada M, Zhao S-G, Endo Y, Furuyama N, Nambu E, Pyko IV, Hayashi Y, Hamada J-I (2011) Silencing of ferrochelatase enhances 5-aminolevulinic acid-based fluorescence and photodynamic therapy efficacy. Br J Cancer 104(5):798–807PubMedCentralPubMedCrossRef

32.

Tsugu A, Ishizaka H, Mizokami Y, Osada T, Baba T, Yoshiyama M, Nishiyama J, Matsumae M (2011) Impact of the combination of 5-aminolevulinic acid-induced fluorescence with intraoperative magnetic resonance imaging-guided surgery for glioma. World Neurosurg 76(1–2):120–127PubMedCrossRef

33.

Warnke PC, Kopitzki K, Timmer J, Ostertag CB (2006) Capillary physiology of human medulloblastoma: impact on chemotherapy. Cancer 107(9):2223–2227PubMedCrossRef

34.

Wisoff JH, Sanford RA, Heier LA, Sposto R, Burger PC, Yates AJ, Holmes EJ, Kun LE (2011) Primary neurosurgery for pediatric low-grade gliomas: a prospective multi-institutional study from the Children’s Oncology Group. Neurosurgery 68(6):1548–1554, discussion 1554–5PubMedCrossRef

35.

Wolburg H, Noell S, Fallier-Becker P, Mack AF, Wolburg-Buchholz K (2012) The disturbed blood–brain barrier in human glioblastoma. Mol Aspects Med 33(5–6):579–589PubMedCrossRef

36.

Yousaf J, Avula S, Abernethy LJ, Mallucci CL (2012) Importance of intraoperative magnetic resonance imaging for pediatric brain tumor surgery. Surg Neurol Int 3(Suppl 2):S65–S72PubMedCentralPubMed

37.

Zeltzer PM, Boyett JM, Finlay JL, Albright AL, Rorke LB, Milstein JM, Allen JC, Stevens KR, Stanley P, Li H, Wisoff JH, Geyer JR, McGuire-Cullen P, Stehbens JA, Shurin SB, Packer RJ (1999) Metastasis stage, adjuvant treatment, and residual tumor are prognostic factors for medulloblastoma in children: conclusions from the Children’s Cancer Group 921 randomized phase III study. J Clin Oncol 17(3):832–845PubMed

Titel: Fluorescence-guided surgery with 5-aminolevulinic acid for resection of brain tumors in children—a technical report
verfasst von: Thomas Beez
Sevgi Sarikaya-Seiwert
Hans-Jakob Steiger
Daniel Hänggi
Publikationsdatum: 01.03.2014
Verlag: Springer Vienna
Erschienen in: Acta Neurochirurgica / Ausgabe 3/2014
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-014-1997-9

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