New chemical solution may assist scientists with brain tumour operations

November 5, 2018

Brain tumours are some of the most complicated tumours to operate on. However, scientists have been testing a drink containing 5-ALA, a substance known to accumulate in fast-growing cancer cells, on people with suspected glioma. The chemical makes brain tumours glow pink and could help surgeons to remove the cancer safely.

The pink glow the chemical causes was found in people with the most aggressive cancers.

Researchers hope it will make it easier for surgeons to distinguish between cancer cells and healthy brain tissue.

Treatment for glioma, the most common form of brain cancer and the one that killed British cabinet minister Dame Tessa Jowell, usually involves surgery to remove as much of the cancer as possible, and the prognosis for patients is often poor.

In the new trial, 99 patients with suspected high-grade (fast-growing) gliomas were given a drink containing 5-ALA before surgery. 5-ALA ends up in fast-growing cancer cells because they lack an enzyme needed to break down the chemical.

Surgeons used microscopes to help them look for fluorescent tissue while removing tumours from the patients’ brains. Surgeons reported seeing fluorescence in 85 patients. Of these, 81 were confirmed by pathologists to have high-grade disease, one was found to have low-grade disease and three could not be assessed. In the 14 patients in whom surgeons did not see any fluorescence, seven tumours were found to be low-grade gliomas while the other seven could not be assessed.

“There’s an urgent need to have something while the patient is on the table, while the neurosurgeon is operating, which will guide them to find the worst bits,” said author Dr. Kathreena Kurian, associate professor in brain tumour research at the University of Bristol.

“The beauty of 5-ALA is that they can see where high-grade glioma is, while they’re operating.”

Next steps could include testing for low-grade tumours as well as in children with brain tumours, or to help surgeons distinguish between tumour tissue and scar tissue in adult patients, whose brain cancers have recurred following treatment.

The National Institute for Health and Clinical Excellence approved the use of 5-ALA for patients with brain tumours, prior to surgery, earlier this year.

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