Clinical utility of 5-aminolevulinic acid HCl to better visualize and more completely remove gliomas

• Authors: Sameer H. Halani, Emory University; David Adamson, Emory University
• Journal Title: OncoTargets and Therapy
• Volume: Volume 9
• Publisher: Dove Medical Press | 2016-01-01, Pages 5629-5642
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.2147/OTT.S97030
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Oncology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Biotechnology & Applied Microbiology; Oncology; aminolevulinic acid; 5-ALA; fluorescence; glioblastoma multiforme; high-grade glioma; resection; FLUORESCENCE-GUIDED SURGERY; PROTOPORPHYRIN IX ACCUMULATION; HISTOLOGY-BASED EVALUATION; GROSS TOTAL RESECTION; MALIGNANT GLIOMAS; INTRAOPERATIVE MRI; BRAIN-TUMORS; PHASE-II

Abstract

Surgical resection is typically the first line of treatment for gliomas. However, the neurosurgeon faces a major challenge in achieving maximal resection in high-grade gliomas as these infiltrative tumors make it difficult to discern tumor margins from normal brain with conventional white-light microscopy alone. To aid in resection of these infiltrative tumors, fluorescence-guided surgery has gained much popularity in intraoperative visualization of malignant gliomas, with 5-aminolevulinic acid (5-ALA) leading the way. First introduced in an article in Neurosurgery, 5-ALA has since become a safe, effective, and inexpensive method to visualize and improve resection of gliomas. This has undoubtedly led to improvements in the clinical course of patients as demonstrated by the increased overall and progression-free survival in patients with such devastating disease. This literature review aims to discuss the major studies and trials demonstrating the clinical utility of 5-ALA and its ability to aid in complete resection of malignant gliomas.