Fluorescence-Based Measurement of Real-Time Kinetics of Protoporphyrin IX After 5-Aminolevulinic Acid Administration in Human In Situ Malignant Gliomas
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BACKGROUND: Five-aminolevulinic acid (5-ALA) is well established for fluorescence-guided resections of malignant gliomas by eliciting the accumulation of fluorescent protoporphyrin IX (PpIX) in tumors. Because of the assumed time point of peak fluorescence, 5-ALA is recommended to be administered 3 h before surgery. However, the actual time dependency of tumor fluorescence has not yet been evaluated in humans and may have important implications. OBJECTIVE: To investigate the time dependency of PpIX by measuring fluorescence intensities in tumors at various time points during surgery. METHODS: Patients received 5-ALA (20 mg/kg b.w.) 3 to 4 h before surgery. Fluorescence intensities (FI) and estimated tumor PpIX concentrations (CPPIX) were measured in the tumors over time with a hyperspectral camera. CPPIX was assessed using hyperspectral imaging and by evaluating fluorescence phantoms with known CPPIX. RESULTS: A total of 201 samples from 68 patients were included in this study. On average, maximum values of calculated FI and CPPIX were observed between 7 and 8 h after 5-ALA administration. FI and CPPIX both reliably distinguished central strong and marginal weak fluorescence, and grade III compared to grade IV gliomas. Interestingly, marginal (weak) fluorescence was observed to peak later than strong fluorescence (8-9 vs 7-8 h). CONCLUSION: In human in Situ brain tumor tissue, we determined fluorescence after 5-ALA administration to be maximal later than previously thought. In consequence, 5-ALA should be administered 4 to 5 h before surgery, with timing adjusted to internal logistical circumstances and factors related to approaching the tumor.
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For gliomas showing weak fluorescence, the peak time of fluorescence is at 8-9 h after ALA administration.
“For gliomas showing weak fluorescence, the peak time of fluorescence is at 8–9 h after ALA administration.”
From 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy (2023) · cites this paper as [70]
Real-time measurement of PpIX fluorescence in high-grade glioma patients indicates the maximum fluorescence at 7-8 h after ALA administration.
“However, real-time measurement of PpIX fluorescence in high-grade glioma patients indicates the maximum fluorescence at 7–8 h [70].”
From 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy (2023) · cites this paper as [70]
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Self-citation
- Authors
- Kaneko, S., Suero Molina, E., Ewelt, C., Warneke, N., & Stummer, W.
- Affiliations
- Hokkaido University (JP)
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
- ORCID
- Stummer, Walter
- Venue
- Neurosurgery
- Published
- 2019-05-06
- Volume
- 85
- Issue
- 4
- Pages
- E739-E746
- ISSN
- 0148-396X (ISSN-L)
- 1524-4040
- OpenAlex
- W2944558620
- Cited by
- 56
- References
- 43
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 7 · 2023: 12 · 2022: 6 · 2021: 11 · 2020: 7 · 2019: 3
- FWCI
- 4.97
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- Neurosurgery (publishedVersion)
- PubMed (publishedVersion)
- German Medical Science (German Research Foundation) (publishedVersion, cc-by)
- German Medical Science (German Research Foundation) (cc-by)
- Funders
- Carl Zeiss Meditec AG
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Photodynamic Therapy Research Studies
- Health Sciences › Medicine › Genetics › Glioma Diagnosis and Treatment
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Optical Imaging and Spectroscopy Techniques
- Keywords
- 5-aminolevulinic acid, protoporphyrin IX, high-grade glioma, fluorescence-guided surgery, fluorescence intensity, glioma grading, timing of surgery, hyperspectral imaging
- MeSH terms
- Adult, Aged, Aged, 80 and over, Aminolevulinic Acid, Brain Neoplasms, Female, Glioma, Humans, Kinetics, Male, Middle Aged, Protoporphyrins, Spectrometry, Fluorescence, Photosensitizing Agents, Young Adult
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