THE USE OF 5-AMINOLEVULINIC ACID (5-ALA) IN HIGH-GRADE GLIOMA SURGERY, A SINGLE CANADIAN CENTER EXPERIENCE

Abstract 5-Aminolevulinic acid (5-ALA) is a prodrug used to selectively illuminate high-grade glioma (HGG) tissue intra-operatively, shown to nearly double complete resection rates in a 2006 multicentre, phase III clinical trial. Here, we review the history of the 2020 approval of 5-ALA in Canada and present some of the first preliminary results on resection rates, survival analysis, and adverse effects from a single Canadian center. METHODS: We enrolled 76 patients (median age 61 years, 42 male) with suspected HGG amenable to surgical resection to undergo 5-ALA fluorescence-guided surgery between June 2020 and January 2023. Gross total resection was defined by the absence of enhancing l esions on postoperative MRI. We compared the survival distributions of confirmed HGG cases with complete vs. incomplete resection using a log-rank test and Kaplan-Meier statistics. RESULTS: 52 patients were confirmed as having a HGG (grade III or IV) based on a pathological diagnosis. In 32 of these patients (60.3%) a gross total resection was achieved. 46 patients of the initial cohort had their surgery done for more than 180 days. 47.8% had a survival of 600 or more days. CONCLUSIONS: 5-ALA fluorescence-guided surgery resulted in high complete resection rates, comparable to literature with no notable adverse side effects.