Protoporphyrin IX Fluorescence and Photobleaching During Interstitial Photodynamic Therapy of Malignant Gliomas for Early Treatment Prognosis. Issue 4 (26th March 2013)

• Record Type: Journal Article
• Authors: Johansson, Ann; Faber, Florian; Kniebühler, Gesa; Stepp, Herbert; Sroka, Ronald; Egensperger, Rupert; Beyer, Wolfgang; Kreth, Friedrich‐Wilhelm
• Is Part Of: Lasers in surgery and medicine. Volume 45:Issue 4(2013)
• Page Start: 225
• Page End: 234
• Publication Date: 2013-03-26
• Subjects: Lasers in medicine -- Periodicals; Lasers in surgery -- Periodicals; 617
• DOI: 10.1002/lsm.22126
• Languages: English
• ISSNs: 0196-8092

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="lsm22126-sec-0001" sec-type="section"> <title>Background and Objective</title> <p>Interstitial photodynamic therapy (iPDT) of non‐resectable recurrent glioblastoma using 5‐aminolevulinic acid (ALA)‐induced protoporphyrin IX (PpIX) has shown a promising outcome. It remained unclear, however, to what extent inter‐ and intra‐tumoural differences of PpIX concentrations influence the efficacy of iPDT. In the current pilot study, we analysed PpIX concentrations quantitatively and assessed PpIX induced fluorescence and photobleaching intraoperatively.</p> </sec> <sec id="lsm22126-sec-0002" sec-type="section"> <title>Materials and Methods</title> <p>Five patients harbouring non‐resectable glioblastomas were included. ALA (20 or 30 mg/kg body weight) was given 5–8 hours before treatment. Stereotactic biopsies were taken throughout the tumour volume for both histological analysis and determination of PpIX concentrations, which were measured by chemical extraction. Cylindrical light diffusors were stereotactically implanted. Prior to and after irradiation, fluorescence measurements were performed. Outcome measurement was based on clinical and neuro‐radiological follow up.</p> </sec> <sec id="lsm22126-sec-0003" sec-type="section"> <title>Results</title> <p>In three patients, a strong PpIX fluorescence was seen before treatment, which was completely photobleached after iPDT. High concentrations of PpIX could be detected in viable tumour parts of these patients (mean PpIX uptake per tumour: 1.4–3.0 µM). In the other two patients, however, no or only low PpIX uptake (0–0.6 µM) could be detected. The patients with strong PpIX uptake showed treatment response and long‐term clinical stabilisation (no progression in 29, 30 and 36 months), early treatment failure was seen in the remaining two patients (death after 3 and 9 months).</p> </sec> <sec id="lsm22126-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Intra‐tumoural PpIX concentrations exhibited pronounced inter‐ and intra‐tumoural variations in glioblastoma, which are directly linked to variable degrees of fluorescence intensity. High intra‐tumoural PpIX concentrations with strong fluorescence intensity and complete photobleaching after iPDT seem to be associated with favourable outcome. Real‐time monitoring of PpIX fluorescence intensity and photobleaching turned out to be feasible and safe and might be employed for early treatment prognosis of iPDT. Lasers Surg. Med. 9999:XX–XX, 2013. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>