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Fluorescence-Guided Surgery Improves Glioma Survival

Al Musella's Comments: (This is his personal views and are not necessarily the views of the Musella Foundation!)


Posted on: 05/01/2006

Fluorescence-Guided Surgery Improves Glioma Survival

NEW YORK APR 27, 2006 (Reuters Health) - Surgical resection aided by a chemical that uses fluorescence to help identify malignant tissue can improve progression-free survival in patients with malignant glioma, according to a report in the May issue of The Lancet Oncology.

Although not fluorescent itself, 5-aminolevulinic acid, which is given orally, causes glioma cells to accumulate fluorescent porphyrins. Under violet-blue light, the cancerous tissue is readily distinguished from nearby healthy tissue.

The new study involved 322 patients with suspected malignant glioma who were randomized to undergo fluorescence-guided resection or conventional resection, lead author Dr. Walter Stummer, from Heinrich-Heine University in Dusseldorf, Germany, and colleagues note. Fifty-two patients were excluded from the current analysis because histological and radiological criteria were not met.

Subjects in the fluorescent surgery group were given 5-aminolevulinic acid 3 hours before anesthesia induction. A special modified operating microscope, capable of switching between white and violet-blue light, was used to perform the fluorescence-guided resections.

The rate of complete resection of contrast-enhancing tumor was 65% in the fluorescent surgery group, much higher than the 36% rate seen in the conventional surgery group (p < 0.0001). Moreover, the 6-month progression-free survival rate was nearly twice as high in the fluorescent surgery group: 41.0% vs. 21.1% (p = 0.0003). Overall survival, however, did not differ significantly between the groups.

The groups were comparable in terms of the frequency and severity of adverse events within 7 days of surgery, the report indicates.

The results suggest that fluorescent-guided surgery is an improvement over conventional surgery for malignant glioma, the authors note. Also, "fluorescence-guided resection by use of 5-aminolevulinic acid is easy to do, and does not interrupt the operation," they add.

Still, further studies are needed to determine the efficacy of such surgery in combination with radiochemotherapy, which has now become a standard treatment for malignant glioma, the researchers note.


Lancet Oncol 2006;7:392-401.

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