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Updated: Apr 13, 2026
An In Vitro Approach to Photodynamic Therapy
Published on: August 17, 2018
Photodynamic diagnosis using 5-aminolevulinic acid for detecting residual ovarian cancer within post-chemotherapy
Kosuke Nakamoto1, Yusuke Matoba2, Takuto Uyama1
1Department of Obstetrics and Gynecology, Graduate School of Biomedical and Health Sciences, Hiroshima University Hospital, Kasumi 1-2-3 Minami-ku, Hiroshima 734-8551, Japan.
Introduction:
5-aminolevulinic acid (5-ALA) photodynamic diagnosis (PDD) facilitates intraoperative identification of malignant lesions. While established in bladder and brain tumors, its utility in advanced ovarian cancer remains limited, particularly for identifying residual disease within post-chemotherapy scarring during interval debulking surgery (IDS). We report a case where 5-ALA PDD identified occult tumors during both diagnostic laparoscopy and IDS.
Case Presentation:
A 74-year-old woman with stage IVB high-grade serous ovarian carcinoma underwent diagnostic laparoscopy followed by three cycles of neoadjuvant chemotherapy (NAC). During subsequent IDS, 5-ALA PDD was employed alongside standard white light imaging. PDD identified peritoneal disseminations that were invisible under white light. Notably, PDD successfully detected viable malignant foci within fibrotic, scar-like lesions modified by NAC, which were otherwise indistinguishable. Although suboptimal debulking was performed due to unresectable nodules near the pancreas, histopathological analysis confirmed malignancy in 100% of PDD-positive sites. No 5-ALA-related adverse events occurred.
Conclusion:
5-ALA PDD may enhance the accuracy of cytoreduction in advanced ovarian cancer by facilitating the detection of residual viable tumors within post-chemotherapy scarring. This technique offers significant diagnostic value in the NAC-IDS setting where conventional inspection is often limited.
