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  • Recurrent Malignant Glioma: Results with the Use of 5-ALA Fluorescence Guided Surgery

    Final Number:

    Miguel Vasconcelos Casimiro MD; Ana Isabel Lopes Luis MD; Carla Reizinho; Jose Cabral

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Malignant gliomas (MG) have a bad prognosis. Gold standard treatment with the combination of surgery, radiotherapy and temozolomide allow an average survival of 15 months. Extent of tumour resection is a known positive prognostic factor, however, the role of an aggressive surgical attitude when facing tumour recurrence is not well established. We aim to access the impact on survival of an aggressive surgical attitude in the treatment of recurrent MG with the use of 5-amminolevulinic acid, fluorescence guided surgery (5-ALA-GS).

    Methods: Retrospective study of all consecutive MG patients treated under 5-ALA-GS from December 2008 to December 2013. The aim of all surgeries was gross total resection of the MRI, TI/gadolinium identifiable tumour. Age, Karnofsky Performance Status prior to surgeries, tumour location, histology, number of gross total resection surgeries and the volume of residual tumour were accessed. All patients were submitted to the same radiotherapy and temozolomide standard protocol. Average overall survival was correlated with the number of gross total resection with 5-ALA-GS. Statistical analysis was calculated with Prism6 v.6.0 for Mac OS-X.

    Results: A total of 66 5-ALA-GS were preformed on 51 patients, followed for 38,3±17 months. The average age of the population was 54,5±12,8 (min.26-max.79). 49,0% were re-operated for the treatment of tumour recurrence with an average of 1,4 surgeries per patient (min.1-max.3). Those had an average survival of 22 months compared with 16 month for the patients who had only one 5-ALA-GS (G-B-Wilcoxon; p<0,05). After 4 years of follow-up, 11,4% of the multiple surgeries patients were still alive. No other statistical significant differences were found between both groups regarding the other prognostic variables studied. Surgical complications rates were similar in both groups.

    Conclusions: An aggressive surgical attitude for the treatment of MG and its recurrence, with the use of 5-ALA-GS, had a positive prognostic impact on average survival. We found an average gain in survival of 6 months (4,3 months per surgery), with no relevant increase in surgical morbidity or mortality.

    Patient Care: Hopefully it will reinforce evidence to encourage a more aggressive surgical attitude when facing a malignant glioma recurrence with clear significant advantage on overall patient survival.

    Learning Objectives: Access the impact on survival of an aggressive surgical attitude in the treatment of recurrent malignant glioma with the use of 5-amminolevulinic acid, fluorescence guided surgery.


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