An Evaluation of the Tolerability and Feasibility of Combining 5-Amino-Levulinic Acid (5-ALA) with BCNU Wafers in the Surgical Management of Primary Glioblastoma.

Autor: Watts C; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK.; Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham B15 2WB, UK., Ashkan K; Department of Neurosurgery, King's College Hospital, London SE5 9RS, UK., Jenkinson MD; Department of Neurosurgery, The Walton Centre, Liverpool L9 7LJ, UK.; Institute of Translational Medicine, University of Liverpool, Liverpool L69 3BX, UK., Price SJ; Academic Neurosurgery Department, University of Cambridge, Cambridge CB2 0QQ, UK., Santarius T; Department of Clinical Neurosciences, Cambridge University Hospitals Foundation Trust, Cambridge CB2 0QQ, UK., Matys T; Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals Foundation Trust, Cambridge CB2 0QQ, UK., Zhang TT; Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals Foundation Trust, Cambridge CB2 0QQ, UK., Finch A; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK., Collins P; Department of Clinical Neurosciences, Cambridge University Hospitals Foundation Trust, Cambridge CB2 0QQ, UK., Allinson K; Department of Histopathology, Cambridge University Hospitals Foundation Trust, Cambridge CB2 0QQ, UK., Jefferies SJ; Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK., Scoffings DJ; Department of Clinical Neurosciences, Cambridge University Hospitals Foundation Trust, Cambridge CB2 0QQ, UK., Zisakis A; Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham B15 2WB, UK., Phillips M; Cancer Institute, University College London, London WC1E 6DD, UK., Wanek K; Cancer Research UK and University College London Cancer Trials Centre, London W1T 4TJ, UK., Smith P; Cancer Research UK and University College London Cancer Trials Centre, London W1T 4TJ, UK., Clifton-Hadley L; Cancer Research UK and University College London Cancer Trials Centre, London W1T 4TJ, UK., Counsell N; Cancer Research UK and University College London Cancer Trials Centre, London W1T 4TJ, UK.
Jazyk: angličtina
Zdroj: Cancers [Cancers (Basel)] 2021 Jun 29; Vol. 13 (13). Date of Electronic Publication: 2021 Jun 29.
DOI: 10.3390/cancers13133241
Abstrakt: Background Glioblastoma (GBM) is the commonest primary malignant brain tumour in adults and effective treatment options are limited. Combining local chemotherapy with enhanced surgical resection using 5-aminolevulinic acid (5-ALA) could improve outcomes. Here we assess the safety and feasibility of combining BCNU wafers with 5-ALA-guided surgery. Methods We conducted a multicentre feasibility study of 5-ALA with BCNU wafers followed by standard-of-care chemoradiotherapy (chemoRT) in patients with suspected GBM. Patients judged suitable for radical resection were administered 5-ALA pre-operatively and BCNU wafers at the end resection. Post-operative treatment continued as per routine clinical practice. The primary objective was to establish if combining 5-ALA and BCNU wafers is safe without compromising patients from receiving standard chemoRT. Results Seventy-two patients were recruited, sixty-four (88.9%) received BCNU wafer implants, and fifty-nine (81.9%) patients remained eligible following formal histological diagnosis. Seven (11.9%) eligible patients suffered surgical complications but only two (3.4%) were not able to begin chemoRT, four (6.8%) additional patients did not begin chemoRT within 6 weeks of surgery due to surgical complications. Eleven (18.6%) patients did not begin chemoRT for other reasons (other toxicity ( n = 3), death ( n = 3), lost to follow-up/withdrew ( n = 3), clinical decision ( n = 1), poor performance status ( n = 1)). Median progression-free survival was 8.7 months (95% CI: 6.4-9.8) and median overall survival was 14.7 months (95% CI: 11.7-16.8). Conclusions Combining BCNU wafers with 5-ALA-guided surgery in newly diagnosed GBM patients is both feasible and tolerable in terms of surgical morbidity and overall toxicity. Any potential therapeutic benefit for the sequential use of 5-ALA and BCNU with chemoRT requires further investigation with improved local delivery technologies.
Databáze: MEDLINE
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