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01.12.2014 | Clinical Article - Pediatrics | Ausgabe 12/2014 Open Access

Acta Neurochirurgica 12/2014

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

Zeitschrift:
Acta Neurochirurgica > Ausgabe 12/2014
Autoren:
Walter Stummer, Floriano Rodrigues, Philippe Schucht, Matthias Preuss, Dorothee Wiewrodt, Ulf Nestler, Marco Stein, José Manuel Cabezudo Artero, Nunzio Platania, Jane Skjøth-Rasmussen, Alessandro Della Puppa, John Caird, Søren Cortnum, Sam Eljamel, Christian Ewald, Laura González-García, Andrew J Martin, Ante Melada, Aurelia Peraud, Angela Brentrup, Thomas Santarius, Hans Herbert Steiner, For the European ALA Pediatric Brain Tumor Study Group

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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