5ALA in pediatric brain tumors is not routinely beneficial

Roth, Jonathan; Constantini, Shlomi

doi:10.1007/s00381-017-3371-8

Cited by 22 publications

(20 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionsupporting

confidence: 83%

“…Despite the good in vitro evidence of MB cells to accumulate PPIX [21, 29-32], the clinical reports of MB fluorescence are conflicting and ambiguous [33][34][35]. Our result of a strong fluorescence rate of 44% is similar to the existing literature [2,[33][34][35]. Our results of the ependymoma grade II group having a strong fluorescence rate of 83% with the grade III group having a 100% strong fluorescence rate is in line with the rate and extent of fluores- cence in clinical studies of both infratentorial [35] and spinal ependymomas [36], approaching 90 and 100% positive strong fluorescence for ependymoma grade II and grade III respectively [35,37,38].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Use of 5-Aminolevulinic Acid to Assist Gross Total Resection of Paediatric Posterior Fossa Tumours

Labuschagne

2020

Pediatr Neurosurg

View full text Add to dashboard Cite

Background: 5-aminolevulinic acid (5-ALA) use is well established in the resection of adult high-grade gliomas. There is growing interest in its usefulness in the paediatric population. The potential benefit of 5-ALA-guided resection motivated our unit to offer the established adult protocol as off-label use. Objective: to determine if 5-ALA guided resection was routinely useful and offered increased gross total resection (GTR) results. Methods: Nineteen patients harbouring a posterior fossa tumour suggestive of either an ependymoma or medulloblastoma (MB) underwent surgery between January 2018 and October 2019. The mean age was 5 years (range 2–12 years). A dose of 20 mg/kg of 5-ALA (Gliolan®) was given 4 h preoperatively. Intraoperatively, the tumours were viewed under violet-blue light and the presence of fluorescence was recorded. Fluorescence status was compared with histopathological classification and grade, Ki-67 index, GTR rate, and a subjective determination of “usefulness” was determined. Results: The case series included ependymoma grade II (n = 6), ependymoma grade III (n = 4), and MB grade IV (n = 9). For the combined cohort, the strong fluorescence rate was 68% (n = 13), the heterogenous fluorescence rate was 26% (n = 5), and the completely negative fluorescence rate was 5% (n = 1). The strong fluorescence rate of 90% found in the combined ependymoma group compared to the 45% strong fluorescence rate in the MB group was statistically significant (p = 0.05). Within the MB group the Ki-67 index was found to be significantly higher in the strongly fluorescent group as opposed to the patchy or non-fluorescent group (77.5 vs. 40%, p = 0.016). Fluorescence was determined to be useful in 63% of all cases. There was no significant relationship between fluorescence and GTR. The relationship between perceived usefulness and resection was not statistically significant. No adverse drug reactions were recorded. Conclusion: This case series adds to the growing body of evidence demonstrating the safety of 5-ALA in the paediatric population. 5-ALA guided resection was found to be useful in the majority of cases but this did not correlate with GTR status. Ependymomas reliably fluoresce in 90% of cases, and 5-ALA-guided resection should be considered when a preoperative diagnosis of ependymoma is suspected.

show abstract

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

The Use of 5-Aminolevulinic Acid to Assist Gross Total Resection of Paediatric Posterior Fossa Tumours

Labuschagne

2020

Pediatr Neurosurg

View full text Add to dashboard Cite

show abstract

“…Orally administered 5-aminolevulinic acid (5-ALA) induces fluorescent porphyrin accumulation within certain tumors, which can be visualized with a modified microscope ( 34 ). The use of 5-ALA in pediatric patients is off label, but has been described ( 11 , 35 ). An RCT in adults found 5-ALA improved the extent of tumor resection and benefitted progression free survival ( 36 ), however evidence in pediatric surgery is limited.…”

Section: Operative Interventionmentioning

confidence: 99%

“…An RCT in adults found 5-ALA improved the extent of tumor resection and benefitted progression free survival ( 36 ), however evidence in pediatric surgery is limited. Roth et al noted that fluorescence is only seen in a small proportion of pediatric brain tumors (outside of glioblastoma multiforme), and therefore advise against the routine use of 5-ALA ( 35 ).…”

Section: Operative Interventionmentioning

confidence: 99%

Pediatric Central Nervous System Tumors: State-of-the-Art and Debated Aspects

2018

View full text Add to dashboard Cite

Pediatric neuro-oncology surgery continues to progress in sophistication, largely driven by advances in technology used to aid the following aspects of surgery: operative planning (advanced MRI techniques including fMRI and DTI), intraoperative navigation [preoperative MRI, intra-operative MRI (ioMRI) and intra-operative ultrasound (ioUS)], tumor visualization (microscopy, endoscopy, fluorescence), tumor resection techniques (ultrasonic aspirator, micro-instruments, micro-endoscopic instruments), delineation of the resection extent (ioMRI, ioUS, and fluorescence), and intraoperative safety (neurophysiological monitoring, ioMRI). This article discusses the aforementioned technological advances, and their multimodal use to optimize safe pediatric neuro-oncology surgery.

show abstract

“…Since its original description it has been a lot of variability on diagnostic criteria and histopathologic classification, but according to the actual graduation of 2016 World Health Organization (WHO), the HPC are grouped with the solitary fibrous tumor, in a way that grade I most often corresponds to the highly collagenous, relatively low cellularity, spindle cell lesion previously diagnosed as solitary fibrous tumor; grade II corresponds typically to the more cellular, less collagenous tumor with plump cells and "staghorn" vasculature that was previously diagnosed in the CNS as hemangiopericytoma; and grade III most often corresponds to what was termed anaplastic hemangiopericytoma in the past, diagnosed on the basis of 5 or more mitoses per 10 high-power fields [5].…”

Section: Introductionmentioning

confidence: 99%

Management of Patients with Hemangiopericytoma: Case Report and Literature Review

Cardoso¹

2019

AJHR

View full text Add to dashboard Cite

The hemangiopericytomas (HPCs) are rare tumors of the dural base and correspond of less than 1% of all primary Central Nervous System (CNS) tumors. It usually affects adult males with 40 to 50 years old and has a supratentorial location (70%), followed by posterior fossa (15%) and spine (15%). Generally, it has fast progression and manifests clinically through headache, focal neurological deficits and epileptic seizures. The tumor has high incidence of local recurrence, from 34% to 90%, and it is estimated that the follow-up of these patients should be done for at least 7, 5 years. The percentage of longdistance metastases is lower, 12% to 55%, affecting especially bones, lungs and liver, in decreasing order. The objective of this study is to evaluate the contradictions when approaching these tumors and to analyze a rare case of pediatric involvement. It was prepared a case report and a literature review was made using the data bases MEDLINE®, PubMed and Cochrane, where 31 relevant articles were selected related to the proposed study. The outcome of HPC treatment can change according to the tumor's location in the CNS or extracranial, the tumor's size and the histopathological classification. Therefore, many studies have been proposed observing the answer of the surgical resection, the adjuvant radiotherapy, the radiosurgery and the antiangiogenic therapies.

show abstract

5ALA in pediatric brain tumors is not routinely beneficial

Cited by 22 publications

References 20 publications

The Use of 5-Aminolevulinic Acid to Assist Gross Total Resection of Paediatric Posterior Fossa Tumours

The Use of 5-Aminolevulinic Acid to Assist Gross Total Resection of Paediatric Posterior Fossa Tumours

Pediatric Central Nervous System Tumors: State-of-the-Art and Debated Aspects

Management of Patients with Hemangiopericytoma: Case Report and Literature Review

Contact Info

Product

Resources

About