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The Use of 5-ALA in Glioblastoma Resection: Two Cases with Long-Term Progression-Free Survival



Abstract

Glioblastoma is the most common and most lethal of all primary brain tumors. Even with the standard triad of surgery, chemotherapy, and radiation therapy, life expectancy is still poor, with a median survival less than 15 months following initial diagnosis. Even though the extent of surgical resection is a prognostic factor affecting outcome, most surgical studies have noted that the complete resection rates are poor due to difficulty in defining the tumor margin intraoperatively. Fluorescence-guided resection (FGR) helps to visualize tumor cells, allowing more complete resection. 5-aminolevulinic acid (5-ALA) in glioma resection has been widely used around the world; however, it is has not been approved in the United States. In this paper, we report two cases of long-term progression-free survival in patients with glioblastoma surgically resected using of 5-ALA.



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Case report
peer-reviewed

The Use of 5-ALA in Glioblastoma Resection: Two Cases with Long-Term Progression-Free Survival


Author Information

Ahmed J. Awad Corresponding Author

Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine

Andrew Sloan

University Hospital Case Medical Center


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. University Hospitals-Case Medical Center issued approval IRB protocol #1305. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
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The Use of 5-ALA in Glioblastoma Resection: Two Cases with Long-Term Progression-Free Survival


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Intraoperative Fluorescence Research

The Use of 5-ALA in Glioblastoma Resection: Two Cases with Long-Term Progression-Free Survival

Ahmed J. Awad">Ahmed J. Awad , Andrew Sloan">Andrew Sloan

  • Author Information
    Ahmed J. Awad Corresponding Author

    Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine

    Andrew Sloan

    University Hospital Case Medical Center


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. University Hospitals-Case Medical Center issued approval IRB protocol #1305. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: September 12, 2014

    DOI

    10.7759/cureus.202

    Cite this article as:

    Awad A J, Sloan A (September 12, 2014) The Use of 5-ALA in Glioblastoma Resection: Two Cases with Long-Term Progression-Free Survival. Cureus 6(9): e202. doi:10.7759/cureus.202

    Publication history

    Received by Cureus: August 30, 2014
    Peer review began: August 31, 2014
    Peer review concluded: September 10, 2014
    Published: September 12, 2014

    Copyright

    © Copyright 2014
    Awad et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Glioblastoma is the most common and most lethal of all primary brain tumors. Even with the standard triad of surgery, chemotherapy, and radiation therapy, life expectancy is still poor, with a median survival less than 15 months following initial diagnosis. Even though the extent of surgical resection is a prognostic factor affecting outcome, most surgical studies have noted that the complete resection rates are poor due to difficulty in defining the tumor margin intraoperatively. Fluorescence-guided resection (FGR) helps to visualize tumor cells, allowing more complete resection. 5-aminolevulinic acid (5-ALA) in glioma resection has been widely used around the world; however, it is has not been approved in the United States. In this paper, we report two cases of long-term progression-free survival in patients with glioblastoma surgically resected using of 5-ALA.



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Ahmed J. Awad, M.D.

Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine

For correspondence:
dr_ahmedja@hotmail.com

Andrew Sloan, M.D.

University Hospital Case Medical Center

Ahmed J. Awad, M.D.

Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine

For correspondence:
dr_ahmedja@hotmail.com

Andrew Sloan, M.D.

University Hospital Case Medical Center