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Low dose 5-aminolevulinic acid: Implications in spectroscopic measurements during brain tumor surgery
Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. (MINT)ORCID iD: 0000-0002-0555-8877
Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery. (MINT)
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pathology and Clinical Genetics.
Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology. (MINT)ORCID iD: 0000-0002-0012-7867
2015 (English)In: Photodiagnosis and Photodynamic Therapy, ISSN 1572-1000, E-ISSN 1873-1597, Vol. 12, no 2, 209-214 p.Article in journal (Refereed) Published
Abstract [en]

Background

Using 5-aminolevulinic acid (ALA) as an intraoperative fluorescence contrast has been proven to improve the resection of glioblastoma and contribute to prolonged patient survival. ALA accumulates as protoporphyrin IX (PpIX) in the tumor cells and is administered in an advised dose of 20 mg/kg body weight (b.w.) for brain tumor resection using fluorescence surgical microscopes. PpIX fluorescence availability and intensities of a four folds lower ALA dose (5 mg/kg b.w.) has been investigated in glioblastomas and skin using a spectroscopy system adapted for surgical guidance.

Methods

A total of 30 adult patients diagnosed with high grade gliomas were included in the analysis. ALA was orally administered in doses of 5 mg/kg b.w. (n = 15) dissolved in orange juice or 20 mg/kg b.w. (n = 15) dissolved in water. A fluorescence spectroscopy system with a handheld fiber-optical probe was used for performing the quantitative fluorescence measurements.

Results

The binominal comparison of the diagnostic performance parameters showed no significant statistical difference (p > 0.05). The median fluorescence values in tumor were 2-3 times higher for the high ALA dose group. No PpIX was detected in the skin of the patients in the low dose group (0/4) while PpIX was detected in the skin of the majority of the patients in the high ALA dose group (13/14).

Conclusions

Application of 5 mg/kg ALA was evaluated as equally reliable as the higher dose regarding the diagnostic performance when guidance was performed using a spectroscopic system. Moreover, no PpIX was detected in the skin of the patients.

Place, publisher, year, edition, pages
Elsevier, 2015. Vol. 12, no 2, 209-214 p.
Keyword [en]
Fluorescence guided surgery, spectroscopy, quantitative, skin photosensitivity, protoporphyrin IX
National Category
Other Medical Engineering
Identifiers
URN: urn:nbn:se:liu:diva-116711DOI: 10.1016/j.pdpdt.2015.03.004ISI: 000356554200007OAI: oai:DiVA.org:liu-116711DiVA: diva2:800094
Funder
Swedish Research CouncilSwedish Foundation for Strategic Research VINNOVA
Available from: 2015-04-01 Created: 2015-04-01 Last updated: 2017-12-04Bibliographically approved

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Haj-Hosseini, NedaRichter, JohanHallbeck, MartinWårdell, Karin
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