title: Long-sustaining response in a patient with non-resectable, distant recurrence of glioblastoma multiforme treated by interstitial photodynamic therapy using 5-ALA: case report.
abstract: Glioblastoma multiforme continues to be a devastating disease despite modest improvements in survival achieved at present, and there is an urgent need for innovative treatment concepts. Five-aminolevulinic acid (ALA) is a drug which induces protoporphyrin IX accumulation in malignant gliomas and has been explored for fluorescence-guided resections of these tumors. ALA is also under investigation as a photosensitizer. We report a case of a patient with prior left frontal glioblastoma multiforme treated by surgery, radiation and chemotherapy, who developed a remote lesion in the left insula, which was refractory to secondary treatments. In a compassionate use setting she was treated by oral application of ALA (20 mg/kg bodyweight), and stereotactic phototherapy achieved by positioning four laser diffusors using 3-dimensional irradiation planning, and a 633 nm diode laser. The lesion disappeared 24 h after therapy. Circumferential contrast enhancement was observed at 72 h, which disappeared in the course of subsequent months. Edema resolved completely. The patient is still free of recurrence 56 months after treatment, demonstrating an impressive and long-lasting response to this novel mode of therapy.
authors.affiliation: Department of Neurosurgery, Heinrich-Heine-University, Moorenstr. 5, 40225, Duesseldorf, Germany. stummer@uni-duesseldorf.de
authors.forename: Walter
authors.initials: W
authors.lastname: Stummer
authors.forename: Tobias
authors.initials: T
authors.lastname: Beck
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Beyer
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Mehrkens
authors.forename: Andreas
authors.initials: A
authors.lastname: Obermeier
authors.forename: Nima
authors.initials: N
authors.lastname: Etminan
authors.forename: Herbert
authors.initials: H
authors.lastname: Stepp
authors.forename: Jörg-Christian
authors.initials: JC
authors.lastname: Tonn
authors.forename: Reinhold
authors.initials: R
authors.lastname: Baumgartner
authors.forename: Jochen
authors.initials: J
authors.lastname: Herms
authors.forename: Friedrich Wilhelm
authors.initials: FW
authors.lastname: Kreth
mesh_terms: D000328:Adult; D000622:Aminolevulinic Acid / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005909:Glioblastoma / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D010789:Phototherapy / Q000379:methods*; D013995:Time
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid