Article ; Online: 5-Aminolevulinic Acid-Guided Surgery for Recurrent Supratentorial Pediatric Neoplasms.
2020 Volume 141, Page(s) e763–e769
Abstract: Background: The use of 5-aminolevulinic acid (5-ALA) in pediatric neuro-oncology is considered off-label, and little data are available on its use in tumor recurrence surgery. Here we present our experience with 5-ALA fluorescence-guided surgery for ... ...
Abstract | Background: The use of 5-aminolevulinic acid (5-ALA) in pediatric neuro-oncology is considered off-label, and little data are available on its use in tumor recurrence surgery. Here we present our experience with 5-ALA fluorescence-guided surgery for recurrent supratentorial tumors in the pediatric population. Methods: Eleven pediatric patients presenting with recurrence of a supratentorial high-grade malignancy (5 glioblastoma [GBM], 6 non-GBM) underwent 5-ALA-assisted surgery. Biopsy specimens were obtained from pathological and normal-appearing areas of the tumor margin. Results: From the margin of the tumor displaying solid fluorescence, a total of 36 samples were obtained. All of these histological samples were found to harbor tumor cells. From areas of vague enhancement, a total of 49 histological samples were taken, of which 38 samples (77%) harbored tumor cells. There was no significant difference in the percentage of biopsy-positive vague fluorescent areas between the GBM cases (80%) and non-GBM cases (75%). A total of 59 biopsy specimens were taken from the tumor margin that appeared completely negative for fluorescence. On analysis, 24 (40.7%) of these specimens demonstrated tumor cells. There was no significant difference in the number of false-negative biopsies between the GBM group (40%) and the non-GBM group (41%). Conclusions: The positive predictive value of solid fluorescence is high in recurrent disease but is substantially lower in areas of vague fluorescence. The rate of false-negative fluorescence is high. 5-ALA should be considered as an adjuvant in revision surgery with the aforementioned caveats in mind. |
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MeSH term(s) | Brain Neoplasms/surgery ; Child ; Child, Preschool ; Female ; Fluorescent Dyes/administration & dosage ; Humans ; Levulinic Acids/administration & dosage ; Magnetic Resonance Imaging/methods ; Male ; Neoplasm Recurrence, Local/surgery ; Neuronavigation/methods ; Neurosurgical Procedures/methods ; Off-Label Use ; Treatment Outcome ; Aminolevulinic Acid |
Chemical Substances | Fluorescent Dyes ; Levulinic Acids |
Language | English |
Publishing date | 2020-06-09 |
Publishing country | United States |
Document type | Journal Article |
ZDB-ID | 2534351-8 |
ISSN | 1878-8769 ; 1878-8750 |
ISSN (online) | 1878-8769 |
ISSN | 1878-8750 |
DOI | 10.1016/j.wneu.2020.06.019 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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