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Interstitial Photodynamic Therapy Using 5-ALA for Malignant Glioma Recurrences.

Stefanie Lietke1,2, Michael Schmutzer1,2, Christoph Schwartz1,3

  • 1Department of Neurosurgery, University Hospital, LMU Munich, 81377 Munich, Germany.

Cancers
|April 30, 2021
PubMed
Summary

Salvage interstitial photodynamic therapy (iPDT) using 5-aminolevulinic acid (5-ALA) offers a feasible treatment for recurrent malignant gliomas. This study found iPDT has a promising outcome and acceptable risk profile, warranting further investigation.

Keywords:
5-ALAglioblastomamalignant gliomaoutcomephotodynamic therapyrecurrencestereotactic surgery

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Area of Science:

  • Oncology
  • Neurosurgery
  • Photomedicine

Background:

  • Malignant gliomas often recur after standard treatments, necessitating alternative therapeutic strategies.
  • Interstitial photodynamic therapy (iPDT) using 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PpIX) shows potential for treating these challenging recurrences.
  • Salvage iPDT is indicated for circumscribed, biopsy-proven malignant glioma recurrences unsuitable for complete resection.

Purpose of the Study:

  • To analyze the risk profile and outcomes of salvage interstitial photodynamic therapy (iPDT) for recurrent malignant gliomas.
  • To evaluate time-to-treatment-failure (TTF) and post-recurrence survival (PRS) in patients undergoing iPDT.
  • To identify potential prognostic factors associated with treatment response in malignant glioma recurrences.

Main Methods:

  • Retrospective analysis of 44 patients with recurrent malignant gliomas treated with iPDT between 2006 and 2018.
  • Stereotactic placement of diffusing fibers guided by 3D treatment-planning software for optimal interstitial irradiation.
  • Outcome measures included procedure risk, TTF, PRS, and analysis of patient characteristics and molecular markers (MGMT, IDH).

Main Results:

  • The median TTF was 7.1 months and the median PRS was 13.0 months.
  • Two- and 5-year PRS rates were 25.0% and 4.5%, respectively.
  • Severe neurologic deterioration occurred in only one patient; treatment response was heterogeneous and not significantly linked to patient or tumor characteristics.

Conclusions:

  • Salvage interstitial photodynamic therapy (iPDT) demonstrates a promising outcome and acceptable safety profile for recurrent malignant gliomas.
  • Further prospective studies are warranted to elucidate mechanisms and identify prognostic factors for favorable treatment responses.
  • iPDT represents a viable therapeutic option for select patients with recurrent gliomas who are not candidates for surgical resection.