title: The role of 5-aminolevulinic acid in brain tumor surgery: a systematic review.
abstract: Recently, 5-aminolevulinic acid (5-ALA) has been utilized as an adjuvant to the surgical resection of primary brain tumors and metastases. We conducted a systematic review of the literature to further understand the role of 5-ALA in neurosurgery. Our goal was to identify the utility of 5-ALA during resection by evaluating its sensitivity and specificity for different tumor types, as well as the extent of tumor resection achieved while using 5-ALA. A search of the literature was conducted using the PubMed database for the period January 1990 through May 2014. Surgical series in which 5-ALA was used for brain neoplasm resections were evaluated for tumor histology, sensitivity, specificity, extent of resection, complications, and outcomes. Twenty-two series, involving 1163 patients, were included in our review. 5-ALA sensitivity was highest in high-grade gliomas (85 %) and meningiomas (81 %). 5-ALA specificity was high in meningiomas (100 %), as well as metastases (84 %) and high-grade gliomas (82 %). Gross total resection (GTR) was achieved using 5-ALA in 66.2 % of all gliomas and 69.6 % of meningiomas, regardless of histological subtype. 5-ALA may be a useful tool in increasing the extent of resection and achieving GTR in intracranial tumors. The resection of tumors for which 5-ALA has high sensitivity and specificity, such as high-grade gliomas, may lead to an increase in extent of resection when compared to operations using only standard white light. Further evidence for the use of 5-ALA in meningiomas and certain subtypes of metastases may be needed to qualify its efficacy.
authors.affiliation: Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, 2nd Floor, Miami, FL, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ferraro
authors.affiliation: Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, 2nd Floor, Miami, FL, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Barbarite
authors.affiliation: College of Osteopathic Medicine, Nova Southeastern University College, Fort Lauderdale, FL, USA.
authors.forename: Trevine R
authors.initials: TR
authors.lastname: Albert
authors.affiliation: Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, 2nd Floor, Miami, FL, USA.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Berchmans
authors.affiliation: Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, 2nd Floor, Miami, FL, USA.
authors.forename: Ashish H
authors.initials: AH
authors.lastname: Shah
authors.affiliation: Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, 2nd Floor, Miami, FL, USA.
authors.forename: Amade
authors.initials: A
authors.lastname: Bregy
authors.affiliation: Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, 2nd Floor, Miami, FL, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Ivan
authors.affiliation: Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, 2nd Floor, Miami, FL, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Brown
authors.affiliation: Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, 2nd Floor, Miami, FL, USA. rkomotar@med.miami.edu.
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Komotar
mesh_terms: D000622:Aminolevulinic Acid; D001932:Brain Neoplasms / Q000601:surgery*; D005456:Fluorescent Dyes; D005910:Glioma / Q000601:surgery*; D006801:Humans; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D038361:Neuronavigation / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods
chemical_list: D005456:Fluorescent Dyes; D000622:Aminolevulinic Acid
keywords: 5-ALA; Brain cancer; Brain metastases; Extent of resection; Glioma; Outcomes; Systematic analysis
references.citation: Neurosurgery. 1998 Mar;42(3):518-25; discussion 525-6
references.pmid: 9526986
references.citation: Neurosurgery. 2009 Dec;65(6):1070-6; discussion 1076-7
references.pmid: 19934966
references.citation: J Neurosurg. 2009 Jan;110(1):156-62
references.pmid: 18847342
references.citation: Neurosurg Focus. 2014 Feb;36(2):E10
references.pmid: 24484248
references.citation: Acta Neurochir (Wien). 2013 Jun;155(6):965-72; discussion 972
references.pmid: 23468036
references.citation: Eur Spine J. 2013 Jun;22(6):1394-401
references.pmid: 23307195
references.citation: Chest. 2006 Mar;129(3):718-24
references.pmid: 16537873
references.citation: Neurosurgery. 2014 Mar;10 Suppl 1:74-82; discussion 82-3
references.pmid: 23887194
references.citation: Photochem Photobiol Sci. 2008 Mar;7(3):283-9
references.pmid: 18389144
references.citation: N Engl J Med. 2001 Jan 11;344(2):114-23
references.pmid: 11150363
references.citation: Nat Rev Cancer. 2006 Jul;6(7):535-45
references.pmid: 16794636
references.citation: Photodiagnosis Photodyn Ther. 2013 Dec;10 (4):379-81
references.pmid: 24284089
references.citation: Neurosurgery. 2009 Jun;64(6):1073-81; discussion 1081
references.pmid: 19487886
references.citation: Diagn Ther Endosc. 1999;5(2):113-8
references.pmid: 18493490
references.citation: J Neurosurg. 2011 Aug;115(2):278-80
references.pmid: 21548751
references.citation: J Neurosurg. 2011 Oct;115(4):740-8
references.pmid: 21761971
references.citation: Neuro Oncol. 2011 Nov;13(11):1234-43
references.pmid: 21824890
references.citation: Lancet Oncol. 2006 May;7(5):392-401
references.pmid: 16648043
references.citation: Acta Neurochir (Wien). 2010 Oct;152(10):1711-9
references.pmid: 20535506
references.citation: Acta Neurochir (Wien). 1998;140(10 ):995-1000
references.pmid: 9856241
references.citation: Brain Tumor Pathol. 2007;24(2):53-5
references.pmid: 18095131
references.citation: Acta Neurochir (Wien). 2012 Apr;154(4):585-8; discussion 588
references.pmid: 22297399
references.citation: Urology. 2008 Aug;72(2):345-8
references.pmid: 18405945
references.citation: Neuro Oncol. 2011 Aug;13(8):846-56
references.pmid: 21798847
references.citation: Neurosurg Focus. 2014 Feb;36(2):E3
references.pmid: 24484256
references.citation: World Neurosurg. 2011 Jul-Aug;76(1-2):120-7
references.pmid: 21839963
references.citation: J Neurosurg. 2006 Apr;104(4):618-20
references.pmid: 16619668
references.citation: J Neurooncol. 2011 Mar;102(1):105-13
references.pmid: 20607351
references.citation: Diagn Ther Endosc. 1999;5(2):71-5
references.pmid: 18493484
references.citation: Neurol Med Chir (Tokyo). 2007 May;47(5):210-3; discussion 213-4
references.pmid: 17527047
references.citation: J Neurosurg. 2010 Aug;113(2):352-7
references.pmid: 19911888
references.citation: J Photochem Photobiol B. 2009 Jun 3;95(3):170-6
references.pmid: 19362851
references.citation: Photomed Laser Surg. 2013 Sep;31(9):428-33
references.pmid: 23869519
references.citation: J Neurosurg. 2011 Mar;114(3):595-603
references.pmid: 20380535
references.citation: PLoS One. 2013 Oct 18;8(10 ):e76988
references.pmid: 24204718
references.citation: Neuro Oncol. 2008 Dec;10(6):1025-34
references.pmid: 18667747
references.citation: Neurosurgery. 2012 Nov;71(5):927-35; discussion 935-6
references.pmid: 22895402
references.citation: Acta Neurochir (Wien). 2012 Feb;154(2):223-8; discussion 228
references.pmid: 22080159
references.citation: Int J Oncol. 2004 Jul;25(1):37-45
references.pmid: 15201987
references.citation: Neurol Neurochir Pol. 2012 Jan-Feb;46(1):47-51
references.pmid: 22426762
references.citation: Neurosurgery. 2008 Mar;62(3 Suppl 1):102-3; discussion 103-4
references.pmid: 18424972
references.citation: J Photochem Photobiol B. 2004 Jan 23;73(1-2):35-42
references.pmid: 14732249
references.citation: Neurosurgery. 2013 Jun;72(2 Suppl Operative):ons159-68; discussion ons168
references.pmid: 23149963
references.citation: Neurosurgery. 2014 Mar;74(3):310-9; discussion 319-20
references.pmid: 24335821
references.citation: Swiss Med Wkly. 2008 Mar 22;138(11-12):180-5
references.pmid: 18363116
references.citation: J Neurosurg. 2011 Mar;114(3):613-23
references.pmid: 20397896
references.citation: J Neurosurg. 2000 Dec;93(6):1003-13
references.pmid: 11117842
references.citation: Neurosurgery. 2008 Apr;62(4):753-64; discussion 264-6
references.pmid: 18496181
references.citation: Br J Cancer. 2011 Sep 27;105(7):961-9
references.pmid: 21863026
references.citation: Cancer. 2010 Mar 15;116(6):1545-52
references.pmid: 20108311