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Photodynamic therapy in glioblastoma: Detection of intraoperative inadvertent 5-ALA mediated photodynamic therapeutical effect after gross total resection

INTRODUCTION: Glioblastoma (GBM) remains the most frequent and lethal primary brain tumor in adults, despite advancements in surgical resection techniques and adjuvant chemo- and radiotherapy. The most frequent recurrence pattern (75-90%) occurs in the form of continuous growth from the border of th...

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Autores principales: Ferrés, Abel, Di Somma, Alberto, Mosteiro, Alejandra, Topczewski, Thomaz Eduardo, Roldán, Pedro, Pedrosa, Leire, Diao, Diouldé, Pineda, Estela, Sierra, Àngels, Enseñat, Joaquim, González-Sánchez, José Juan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9755173/
https://www.ncbi.nlm.nih.gov/pubmed/36531012
http://dx.doi.org/10.3389/fonc.2022.1080685
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author Ferrés, Abel
Di Somma, Alberto
Mosteiro, Alejandra
Topczewski, Thomaz Eduardo
Roldán, Pedro
Pedrosa, Leire
Diao, Diouldé
Pineda, Estela
Sierra, Àngels
Enseñat, Joaquim
González-Sánchez, José Juan
author_facet Ferrés, Abel
Di Somma, Alberto
Mosteiro, Alejandra
Topczewski, Thomaz Eduardo
Roldán, Pedro
Pedrosa, Leire
Diao, Diouldé
Pineda, Estela
Sierra, Àngels
Enseñat, Joaquim
González-Sánchez, José Juan
author_sort Ferrés, Abel
collection PubMed
description INTRODUCTION: Glioblastoma (GBM) remains the most frequent and lethal primary brain tumor in adults, despite advancements in surgical resection techniques and adjuvant chemo- and radiotherapy. The most frequent recurrence pattern (75-90%) occurs in the form of continuous growth from the border of the surgical cavity, thus emphasizing the need for locoregional tumor control. Fluorescence-guided surgical resection using 5-ALA has been widely implemented in surgical protocols for such tumors. Recent literature also highlights the applicability of 5-ALA-mediated photodynamic therapy to obtain locoregional tumor control further. This study aims to identify if 5-ALA mediated photodynamic therapeutic effect after gross total glioblastoma resection has inadvertently occurred due to the exposition of protoporphyrin IX charged peripheral tumoral cells to operative room light sources. METHODS: Of 146 patients who were intervened from glioblastoma between 2015 and 2020, 33 were included in the present study. Strict gross total resection (without supralocal resection) had been accomplished, and adjuvant chemoradiotherapy protocol was administered. Two comparison groups were created regarding the location of the recurrence (group A: up to 1 centimeter from the surgical cavity, and group B: beyond 1 centimeter from the surgical cavity). The cutoff point was determined to be 1 centimeter because of the visible light penetrance to the normal brain tissue. RESULTS: In univariate analysis, both groups only differed regarding 5-ALA administration, which was significantly related to a minor relative risk of presenting the recurrence within the first centimeter from the surgical cavity (Relative Risk = 0,655 (95% CI 0,442-0,970), p-value=0,046). Results obtained in univariate analysis were corroborated posteriorly in multivariate analysis (RR=0,730 (95% CI 0,340-0,980), p=0,017). DISCUSSION: In the present study, a probable inadvertent 5-ALA photodynamic therapeutical effect has been detected in vivo. This finding widely opens the door for further research on this promising theragnostic tool.
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spelling pubmed-97551732022-12-17 Photodynamic therapy in glioblastoma: Detection of intraoperative inadvertent 5-ALA mediated photodynamic therapeutical effect after gross total resection Ferrés, Abel Di Somma, Alberto Mosteiro, Alejandra Topczewski, Thomaz Eduardo Roldán, Pedro Pedrosa, Leire Diao, Diouldé Pineda, Estela Sierra, Àngels Enseñat, Joaquim González-Sánchez, José Juan Front Oncol Oncology INTRODUCTION: Glioblastoma (GBM) remains the most frequent and lethal primary brain tumor in adults, despite advancements in surgical resection techniques and adjuvant chemo- and radiotherapy. The most frequent recurrence pattern (75-90%) occurs in the form of continuous growth from the border of the surgical cavity, thus emphasizing the need for locoregional tumor control. Fluorescence-guided surgical resection using 5-ALA has been widely implemented in surgical protocols for such tumors. Recent literature also highlights the applicability of 5-ALA-mediated photodynamic therapy to obtain locoregional tumor control further. This study aims to identify if 5-ALA mediated photodynamic therapeutic effect after gross total glioblastoma resection has inadvertently occurred due to the exposition of protoporphyrin IX charged peripheral tumoral cells to operative room light sources. METHODS: Of 146 patients who were intervened from glioblastoma between 2015 and 2020, 33 were included in the present study. Strict gross total resection (without supralocal resection) had been accomplished, and adjuvant chemoradiotherapy protocol was administered. Two comparison groups were created regarding the location of the recurrence (group A: up to 1 centimeter from the surgical cavity, and group B: beyond 1 centimeter from the surgical cavity). The cutoff point was determined to be 1 centimeter because of the visible light penetrance to the normal brain tissue. RESULTS: In univariate analysis, both groups only differed regarding 5-ALA administration, which was significantly related to a minor relative risk of presenting the recurrence within the first centimeter from the surgical cavity (Relative Risk = 0,655 (95% CI 0,442-0,970), p-value=0,046). Results obtained in univariate analysis were corroborated posteriorly in multivariate analysis (RR=0,730 (95% CI 0,340-0,980), p=0,017). DISCUSSION: In the present study, a probable inadvertent 5-ALA photodynamic therapeutical effect has been detected in vivo. This finding widely opens the door for further research on this promising theragnostic tool. Frontiers Media S.A. 2022-12-02 /pmc/articles/PMC9755173/ /pubmed/36531012 http://dx.doi.org/10.3389/fonc.2022.1080685 Text en Copyright © 2022 Ferrés, Di Somma, Mosteiro, Topczewski, Roldán, Pedrosa, Diao, Pineda, Sierra, Enseñat and González-Sánchez https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Ferrés, Abel
Di Somma, Alberto
Mosteiro, Alejandra
Topczewski, Thomaz Eduardo
Roldán, Pedro
Pedrosa, Leire
Diao, Diouldé
Pineda, Estela
Sierra, Àngels
Enseñat, Joaquim
González-Sánchez, José Juan
Photodynamic therapy in glioblastoma: Detection of intraoperative inadvertent 5-ALA mediated photodynamic therapeutical effect after gross total resection
title Photodynamic therapy in glioblastoma: Detection of intraoperative inadvertent 5-ALA mediated photodynamic therapeutical effect after gross total resection
title_full Photodynamic therapy in glioblastoma: Detection of intraoperative inadvertent 5-ALA mediated photodynamic therapeutical effect after gross total resection
title_fullStr Photodynamic therapy in glioblastoma: Detection of intraoperative inadvertent 5-ALA mediated photodynamic therapeutical effect after gross total resection
title_full_unstemmed Photodynamic therapy in glioblastoma: Detection of intraoperative inadvertent 5-ALA mediated photodynamic therapeutical effect after gross total resection
title_short Photodynamic therapy in glioblastoma: Detection of intraoperative inadvertent 5-ALA mediated photodynamic therapeutical effect after gross total resection
title_sort photodynamic therapy in glioblastoma: detection of intraoperative inadvertent 5-ala mediated photodynamic therapeutical effect after gross total resection
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9755173/
https://www.ncbi.nlm.nih.gov/pubmed/36531012
http://dx.doi.org/10.3389/fonc.2022.1080685
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