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Pharmaceutical equivalent 5-aminolevulinic acid fluorescence guided resection of central nervous system tumors: feasibility, safeness and cost-benefit considerations

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Abstract

Purpose

5-aminolevulinic acid (5-ALA) fluorescence-guided resection (FGR) has been an essential tool in the ‘standard of care’ of malignant gliomas. Over the last two decades, its indications have been extended to other neoplasms, such as metastases and meningiomas. However, its availability and cost-benefit still pose a challenge for widespread use. The present article reports a retrospective series of 707 cases of central nervous system (CNS) tumors submitted to FGR with pharmacological equivalent 5-ALA and discusses financial implications, feasibility and safeness.

Methods

From December 2015 to February 2024, a retrospective single institution series of 707 cases of 5-ALA FGR were analyzed. Age, gender, 5-ALA dosage, intraoperative fluorescence finding, diagnosis and adverse effects were recorded. Financial impact in the surgical treatment cost were also reported.

Results

there was an additional cost estimated in $300 dollars for each case, increasing from 2,37 to 3,28% of the total hospitalization cost. There were 19 (2,69%) cases of asymptomatic photosensitive reaction and 2 (0,28%) cases of photosensitive reaction requiring symptomatic treatment. 1 (0,14%) patient had a cutaneous rash sustained for up to 10 days. No other complications related to the method were evident. In 3 (0,42%) cases of patients with intracranial hypertension, there was vomiting after administration.

Conclusion

FGR with pharmacological equivalent 5-ALA can be considered safe and efficient and incorporates a small increase in hospital expenses. It constitutes a reliable solution in avoiding prohibitive costs worldwide, especially in countries where commercial 5-ALA is unavailable.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank professor Fábio Alberto Silva for the assistance with the grammar revision.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Division of Neurooncology, Department of Neurosurgery, Instituto de Neurologia de Curitiba, Rua Jeremias Maciel Perretto, 300 - Campo Comprido, 81210-310, Curitiba, PR, Brazil

    Erasmo Barros da Silva Jr, Ricardo Ramina, Jorge Luis Novak Filho, Gustavo Simiano Jung, Giulia Xavier Bornancin & Maurício Coelho Neto

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  1. Erasmo Barros da Silva Jr
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  2. Ricardo Ramina
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  3. Jorge Luis Novak Filho
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Contributions

The authors confirm contribution to the paper as follows: study conception and design: da Silva Jr EB; data collection: Novak Filho JL, Bornancin GX; analysis and interpretation of results: Jung GS, Neto MC, Ramina R; draft manuscript preparation: da Silva Jr EB, Ramina R. All authors reviewed the results and approved the final version of the manuscript.

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Correspondence to Erasmo Barros da Silva Jr.

Ethics declarations

Ethical approval

Ethical approval was waived by the local ethical committee due to the retrospective nature of this study. All procedures performed in this article were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All patients submitted to 5-ALA FGR were informed about the off-label character of the compound and provided informed consent. All cases were discussed and approved by interdisciplinary neuro-oncological tumor board.

Consent for participate

Informed consent was obtained from all individual participants submitted to 5-ALA FGR included in the retrospective series of this study.

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The author confirms that the work described has not been published before (except in the form of an abstract or as part of a published lecture, review, or thesis); that it is not under consideration for publication elsewhere; that its publication has been approved by all co-authors, if any; that its publication has been approved (tacitly or explicitly) by the responsible authorities at the institution where the work is carried out.

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da Silva Jr, E.B., Ramina, R., Novak Filho, J.L. et al. Pharmaceutical equivalent 5-aminolevulinic acid fluorescence guided resection of central nervous system tumors: feasibility, safeness and cost-benefit considerations. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04698-z

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