Efficacy, Outcome, and Safety of Elderly Patients with Glioblastoma in the 5-ALA Era: Single Center Experience of More Than 10 Years
Background: In the next decades, the incidence of patients with glioblastoma (GBM) will increase due to the growth of the elderly population. Fluorescence-guided resection using 5-aminolevulinic acid (5-ALA) is widely applied to achieve maximal safe resection of GBM and is identified as a novel intr...
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| Format: | Article |
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MDPI AG
2021-12-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/23/6119 |
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| author | Barbara Kiesel Lisa I. Wadiura Mario Mischkulnig Jessica Makolli Veronika Sperl Martin Borkovec Julia Freund Alexandra Lang Matthias Millesi Anna S. Berghoff Julia Furtner Adelheid Woehrer Georg Widhalm |
| author_facet | Barbara Kiesel Lisa I. Wadiura Mario Mischkulnig Jessica Makolli Veronika Sperl Martin Borkovec Julia Freund Alexandra Lang Matthias Millesi Anna S. Berghoff Julia Furtner Adelheid Woehrer Georg Widhalm |
| author_sort | Barbara Kiesel |
| collection | DOAJ |
| description | Background: In the next decades, the incidence of patients with glioblastoma (GBM) will increase due to the growth of the elderly population. Fluorescence-guided resection using 5-aminolevulinic acid (5-ALA) is widely applied to achieve maximal safe resection of GBM and is identified as a novel intraoperative marker for diagnostic tissue during biopsies. However, detailed analyses of the use of 5-ALA in resections as well as biopsies in a large elderly cohort are still missing. The aim of this study was thus to investigate the efficacy, outcome, and safety of surgically- treated GBM in the 5-ALA era in a large elderly cohort. Methods: All GBM patients aged 65 years or older who underwent neurosurgical intervention between 2007 and 2019 were included. Data on 5-ALA application, intraoperative fluorescence status, and 5-ALA-related side effects were derived from our databank. In the case of resection, the tumor resectability and the extent of resection were determined. Potential prognostic parameters relevant for overall survival were analyzed. Results: 272 GBM patients with a median age of 71 years were included. Intraoperative 5-ALA fluorescence was applied in most neurosurgical procedures (<i>n</i> = 255/272, 88%) and visible fluorescence was detected in most cases (<i>n</i> = 252/255, 99%). In biopsies, 5-ALA was capable of visualizing tumor tissue by visible fluorescence in all but one case (<i>n</i> = 91/92, 99%). 5-ALA administration did not result in any severe side effects. Regarding patient outcome, smaller preoperative tumor volume (<22.75 cm<sup>3</sup>), gross total resection, single lesions, improved postoperative neurological status, and concomitant radio-chemotherapy showed a significantly longer overall survival. Conclusions: Our data of this large elderly cohort demonstrate the clinical utility and safety of 5-ALA fluorescence in GBM for improved tumor visualization in both resections as well as biopsies. Therefore, we recommend the use of 5-ALA not only in resections, but also in open/stereotactic biopsies to optimize the neurosurgical management of elderly GBM patients. |
| first_indexed | 2024-03-10T04:55:09Z |
| format | Article |
| id | doaj.art-511b0096679f4baa9a1ec2938013b2f4 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T04:55:09Z |
| publishDate | 2021-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-511b0096679f4baa9a1ec2938013b2f42023-11-23T02:14:57ZengMDPI AGCancers2072-66942021-12-011323611910.3390/cancers13236119Efficacy, Outcome, and Safety of Elderly Patients with Glioblastoma in the 5-ALA Era: Single Center Experience of More Than 10 YearsBarbara Kiesel0Lisa I. Wadiura1Mario Mischkulnig2Jessica Makolli3Veronika Sperl4Martin Borkovec5Julia Freund6Alexandra Lang7Matthias Millesi8Anna S. Berghoff9Julia Furtner10Adelheid Woehrer11Georg Widhalm12Department of Neurosurgery, Medical University Vienna, 1090 Vienna, AustriaDepartment of Neurosurgery, Medical University Vienna, 1090 Vienna, AustriaDepartment of Neurosurgery, Medical University Vienna, 1090 Vienna, AustriaDepartment of Neurosurgery, Medical University Vienna, 1090 Vienna, AustriaDepartment of Neurosurgery, Medical University Vienna, 1090 Vienna, AustriaDepartment of Neurosurgery, Medical University Vienna, 1090 Vienna, AustriaDepartment of Neurosurgery, Medical University Vienna, 1090 Vienna, AustriaDepartment of Neurosurgery, Medical University Vienna, 1090 Vienna, AustriaDepartment of Neurosurgery, Medical University Vienna, 1090 Vienna, AustriaDepartment of Medicine I, Clinical Division of Oncology, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, 1090 Vienna, AustriaDepartment of Neurology, Institute of Neuropathology and Neurochemistry, Medical University Vienna, 1090 Vienna, AustriaDepartment of Neurosurgery, Medical University Vienna, 1090 Vienna, AustriaBackground: In the next decades, the incidence of patients with glioblastoma (GBM) will increase due to the growth of the elderly population. Fluorescence-guided resection using 5-aminolevulinic acid (5-ALA) is widely applied to achieve maximal safe resection of GBM and is identified as a novel intraoperative marker for diagnostic tissue during biopsies. However, detailed analyses of the use of 5-ALA in resections as well as biopsies in a large elderly cohort are still missing. The aim of this study was thus to investigate the efficacy, outcome, and safety of surgically- treated GBM in the 5-ALA era in a large elderly cohort. Methods: All GBM patients aged 65 years or older who underwent neurosurgical intervention between 2007 and 2019 were included. Data on 5-ALA application, intraoperative fluorescence status, and 5-ALA-related side effects were derived from our databank. In the case of resection, the tumor resectability and the extent of resection were determined. Potential prognostic parameters relevant for overall survival were analyzed. Results: 272 GBM patients with a median age of 71 years were included. Intraoperative 5-ALA fluorescence was applied in most neurosurgical procedures (<i>n</i> = 255/272, 88%) and visible fluorescence was detected in most cases (<i>n</i> = 252/255, 99%). In biopsies, 5-ALA was capable of visualizing tumor tissue by visible fluorescence in all but one case (<i>n</i> = 91/92, 99%). 5-ALA administration did not result in any severe side effects. Regarding patient outcome, smaller preoperative tumor volume (<22.75 cm<sup>3</sup>), gross total resection, single lesions, improved postoperative neurological status, and concomitant radio-chemotherapy showed a significantly longer overall survival. Conclusions: Our data of this large elderly cohort demonstrate the clinical utility and safety of 5-ALA fluorescence in GBM for improved tumor visualization in both resections as well as biopsies. Therefore, we recommend the use of 5-ALA not only in resections, but also in open/stereotactic biopsies to optimize the neurosurgical management of elderly GBM patients.https://www.mdpi.com/2072-6694/13/23/6119elderly patientsglioblastoma5-aminolevulinic acidresectionbiopsy |
| spellingShingle | Barbara Kiesel Lisa I. Wadiura Mario Mischkulnig Jessica Makolli Veronika Sperl Martin Borkovec Julia Freund Alexandra Lang Matthias Millesi Anna S. Berghoff Julia Furtner Adelheid Woehrer Georg Widhalm Efficacy, Outcome, and Safety of Elderly Patients with Glioblastoma in the 5-ALA Era: Single Center Experience of More Than 10 Years Cancers elderly patients glioblastoma 5-aminolevulinic acid resection biopsy |
| title | Efficacy, Outcome, and Safety of Elderly Patients with Glioblastoma in the 5-ALA Era: Single Center Experience of More Than 10 Years |
| title_full | Efficacy, Outcome, and Safety of Elderly Patients with Glioblastoma in the 5-ALA Era: Single Center Experience of More Than 10 Years |
| title_fullStr | Efficacy, Outcome, and Safety of Elderly Patients with Glioblastoma in the 5-ALA Era: Single Center Experience of More Than 10 Years |
| title_full_unstemmed | Efficacy, Outcome, and Safety of Elderly Patients with Glioblastoma in the 5-ALA Era: Single Center Experience of More Than 10 Years |
| title_short | Efficacy, Outcome, and Safety of Elderly Patients with Glioblastoma in the 5-ALA Era: Single Center Experience of More Than 10 Years |
| title_sort | efficacy outcome and safety of elderly patients with glioblastoma in the 5 ala era single center experience of more than 10 years |
| topic | elderly patients glioblastoma 5-aminolevulinic acid resection biopsy |
| url | https://www.mdpi.com/2072-6694/13/23/6119 |
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