How 5-ALA enlightens neurosurgery - results of a single centre study on high-grade gliomas.

Abstract

Introduction and objective: This study aims to assess the effectiveness of the use of intraoperative fluorescence with 5-ALA on the scope on the resection and the results of the treatment of patients. Despite the continuous development of new oncological treatments, surgical resection remains the basis for treating high-grade gliomas. For this reason, methods are introduced to facilitate the removal of the tumour in a maximally complete and safe manner for the patient.

Material and methods: The effects were examined of intraoperative fluorescence using 5-aminolevulinic acid (5-ALA). The volumetric extent of resection and the outcome of 39 cases of patients with high-grade gliomas operated on using intraoperative fluorescence were compared with 5-ALA and patients undergoing resection using a white-light microscope.

Results: The use of 5-ALA during the procedure increased the extent of resection compared to procedures under white light: - 96.14% vs. 90.69%. Interestingly, when focused on recurrent high-grade gliomas, better results were observed for the white-light group. There was also an improvement in the overall survival (OS) of patients operated on with 5-ALA (p=0.0485). OS for the study group was 9.97 months compared to 6.40 months for the control group.

Conclusions: Based on the observations, the use of 5-ALA in surgery for high-grade gliomas allows for an increase in the extent of resection performed and an improvement in patient prognosis. Moreover, the use of 5-ALA shows better results for primary tumours when compared to recurrent ones (p<0.0001 for primary gliomas).