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Five-aminolevulinic acid for fluorescence-guided resection of recurrent malignant gliomas: A phase II study
Neurosurgery, 11/25/09
Arya N et al. – 5-ALA fluorescence has a high predictive value for the detection of tumor in recurrent gliomas. Prior treatment modalities, such as radiation or chemotherapy, do not invalidate the fluorescence guidance with 5-ALA. 5-ALA fluorescence guidance is an effective surgical adjunct in the surgery of recurrent malignant gliomas
Methods- Multicenter prospective, single-arm, uncontrolled phase II study, 36 patients with recurrent glioma (World Health Organization grade III/IV) received 5-ALA before surgery
- After microsurgical resection, biopsies from pathological and nonpathological areas (as identified under conventional white light) were obtained to determine the positive predictive value (PPV) of 5-ALA-induced tissue fluorescence in detecting tumors
- Adverse events, neurological examinations, and survival data documented for minimal follow-up of 6 mos
- Patient-based PPV, defined as percentage of patients showing positive tumor cell identification in all biopsies taken from areas of weak and strong fluorescence was 97.2% for pathological areas and 79.4% in nonpathological areas
- Within areas of strong fluorescence, PPV higher (91.7%) compared with that of weak fluorescence (82.4%)
- On biopsy level for nonpathological-appearing tissue under white light (157 biopsies) the PPV of tissue fluorescence was 93.0% compared with 99.5% in pathological-appearing tissue (197 biopsies)
- Within areas of strong fluorescence, PPV was higher (96.9%) compared with that of weak fluorescence (90.3%)
- No adverse events pertaining to study drug
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