Long-sustaining response in a patient with non-resectable, distant recurrence of glioblastoma multiforme treated by interstitial photodynamic therapy using 5-ALA: case report

• DOI: 10.1007/s11060-007-9497-x
• Publication Date: 2007-11-22T08:22:58Z
• Authors: Walter Stummer; Tobias Beck; Wolfgang Beyer; Jan Hendrik Mehrkens; Andreas Obermeier; Nima Etminan; Herbert Stepp; Jörg-Christian Tonn; Reinhold Baumgartner; Jochen Herms; Friedrich Wilhelm...
• Keywords: Adult; Photosensitizing Agents; Brain Neoplasms; Aminolevulinic Acid; Phototherapy; Combined Modality Therapy; Magnetic Resonance Imaging; Time; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Humans; Female; Neoplasm Recurrence, Local; Glioblastoma

Glioblastoma multiforme continues to be a devastating disease despite modest improvements in survival achieved at present, and there is an urgent need for innovative treatment concepts. Five-aminolevulinic acid (ALA) is a drug which induces protoporphyrin IX accumulation in malignant gliomas and has been explored for fluorescence-guided resections of these tumors. ALA is also under investigation as a photosensitizer. We report a case of a patient with prior left frontal glioblastoma multiforme treated by surgery, radiation and chemotherapy, who developed a remote lesion in the left insula, which was refractory to secondary treatments. In a compassionate use setting she was treated by oral application of ALA (20 mg/kg bodyweight), and stereotactic phototherapy achieved by positioning four laser diffusors using 3-dimensional irradiation planning, and a 633 nm diode laser. The lesion disappeared 24 h after therapy. Circumferential contrast enhancement was observed at 72 h, which disappeared in the course of subsequent months. Edema resolved completely. The patient is still free of recurrence 56 months after treatment, demonstrating an impressive and long-lasting response to this novel mode of therapy.