Long-sustaining response in a patient with non-resectable, distant recurrence of glioblastoma multiforme treated by interstitial photodynamic therapy using 5-ALA: case report.
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.
Stummer
Walter
W
Department of Neurosurgery, Heinrich-Heine-University, Moorenstr. 5, 40225, Duesseldorf, Germany. stummer@uni-duesseldorf.de
Beck
Tobias
T
Beyer
Wolfgang
W
Mehrkens
Jan Hendrik
JH
Obermeier
Andreas
A
Etminan
Nima
N
Stepp
Herbert
H
Tonn
Jörg-Christian
JC
Baumgartner
Reinhold
R
Herms
Jochen
J
Kreth
Friedrich Wilhelm
FW
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
D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid