Clinical utility of 5-aminolevulinic acid HCl to better visualize and more completely remove gliomas.
Surgical resection is typically the first line of treatment for gliomas. However, the neurosurgeon faces a major challenge in achieving maximal resection in high-grade gliomas as these infiltrative tumors make it difficult to discern tumor margins from normal brain with conventional white-light microscopy alone. To aid in resection of these infiltrative tumors, fluorescence-guided surgery has gained much popularity in intraoperative visualization of malignant gliomas, with 5-aminolevulinic acid (5-ALA) leading the way. First introduced in an article in Neurosurgery, 5-ALA has since become a safe, effective, and inexpensive method to visualize and improve resection of gliomas. This has undoubtedly led to improvements in the clinical course of patients as demonstrated by the increased overall and progression-free survival in patients with such devastating disease. This literature review aims to discuss the major studies and trials demonstrating the clinical utility of 5-ALA and its ability to aid in complete resection of malignant gliomas.
Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
Sameer H
SH
Halani
Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA; Neurosurgery Section, Atlanta VA Medical Center, Decatur, GA, USA.
D Cory
DC
Adamson
5-ALA; aminolevulinic acid; fluorescence; glioblastoma multiforme; high-grade glioma; resection
Neurosurgery. 1998 Mar;42(3):518-25; discussion 525-6
9526986
Br J Cancer. 2003 Aug 18;89(4):730-6
12915887
Neurosurgery. 2016 Apr;78(4):475-83
26407129
Neurosurgery. 2009 Dec;65(6):1070-6; discussion 1076-7
19934966
Neurosurgery. 2016 Mar;78(3):401-11; discussion 411
26366972
Acta Neurochir (Wien). 2013 Jun;155(6):965-72; discussion 972
23468036
PLoS One. 2012;7(9):e44885
23049761
N Engl J Med. 2001 Jan 11;344(2):114-23
11150363
Lasers Med Sci. 2008 Oct;23(4):361-7
17926079
J Photochem Photobiol B. 1998 Sep;45(2-3):160-9
9868806
Pathobiology. 2009;76(6):303-14
19955842
Neurosurgery. 2015 Nov;77(5):663-73
26308630
Clin Neurosurg. 2008;55:20-6
19248665
J Neurosurg. 2011 Oct;115(4):740-8
21761971
Brain Res. 2003 Jan 10;959(2):226-34
12493610
Neurocirugia (Astur). 2012 Feb;23(1):23-8
22520100
Lancet Oncol. 2006 May;7(5):392-401
16648043
Neurosurgery. 2011 Jun;68(2 Suppl Operative):282-90; discussion 290
21336204
J Clin Neurosci. 2013 May;20(5):670-5
23352352
N Engl J Med. 2015 Jun 25;372(26):2481-98
26061751
Neuro Oncol. 2014 Oct;16(10):1400-7
24723565
Neurosurg Focus. 2014 Feb;36(2):E3
24484256
World Neurosurg. 2011 Jul-Aug;76(1-2):120-7
21839963
J Huazhong Univ Sci Technolog Med Sci. 2009 Dec;29(6):765-70
20037824
J Neurooncol. 2011 Mar;102(1):105-13
20607351
Neurol Med Chir (Tokyo). 2007 May;47(5):210-3; discussion 213-4
17527047
Photodiagnosis Photodyn Ther. 2008 Dec;5(4):260-3
19356667
Neurosurgery. 2013 Jun;72(6):915-20; discussion 920-1
23685503
J Neurosurg. 2016 May;124(5):1300-9
26544781
Acta Neuropathol. 2007 Aug;114(2):97-109
17618441
Neurosurgery. 2012 Jan;70(1):234-43; discussion 243-4
21593697
PLoS One. 2013 May 28;8(5):e63682
23723993
PLoS One. 2015 Jun 26;10(6):e0131872
26115409
Clin Neurosurg. 2009;56:93-7
20214039
Mol Imaging Biol. 2016 Jun;18(3):454-62
26463215
Neurosurg Focus. 2014 Dec;37(6):E16
25434385
Cochrane Database Syst Rev. 2014 Jan 28;(1):CD009685
24474579
Neurosurgery. 2012 Nov;71(5):927-35; discussion 935-6
22895402
Acta Neurochir (Wien). 2012 Feb;154(2):223-8; discussion 228
22080159
Ann Surg Oncol. 2013 Dec;20(13):4379-88
22688660
J Neurosurg. 2015 Sep;123(3):771-80
26140489
Neurosurg Clin N Am. 2012 Jul;23(3):371-7
22748650
Acta Neurochir Suppl. 2003;88:9-12
14531555
Acta Neurochir (Wien). 2015 Feb;157(2):207-13; discussion 213-4
25547719
Curr Drug Discov Technol. 2012 Dec;9(4):256-67
22339071
Neurosurgery. 2014 Mar;74(3):310-9; discussion 319-20
24335821
Neuro Oncol. 2014 Jan;16(1):113-22
24285550
Urology. 1999 Jan;53(1):77-81
9886592
Swiss Med Wkly. 2008 Mar 22;138(11-12):180-5
18363116
Clin Neurol Neurosurg. 2015 Mar;130:134-9
25615582
J Neurosurg. 2011 Mar;114(3):613-23
20397896
Neuro Oncol. 2013 Nov;15 Suppl 2:ii1-56
24137015
Neurosurgery. 2016 Apr;78(4):484-6
26552043
Neuro Oncol. 2015 Dec;17(12):1560-7
25858636
Spine (Phila Pa 1976). 2006 Apr 20;31(9):E268-70
16641768
J Neurosurg. 2000 Dec;93(6):1003-13
11117842
Mol Cell Oncol. 2015 Jul 29;3(2):e1074333
27308595
J Neurooncol. 2011 Jun;103(2):361-70
20922459
J Neurosurg. 2001 Aug;95(2):190-8
11780887