Article
Impact of antiepileptic drug treatment on 5-aminolevulinic acid fluorescence expression in IDH-1 wild-type glioblastoma
Einfluss von Antiepileptika auf die 5-ALA Fluoreszenz bei IDH-1 wild-typ Glioblastomen
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Published: | May 25, 2022 |
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Objective: 5-aminolevulinic acid (5-ALA) is the most established neurosurgical fluorescent dye and facilitates the achievement of gross total resection in glioblastoma (GB). In-vitro studies raised the concern that antiepileptic drugs (AED) might reduce the fluorescence quality.
Methods: Between 2013 and 2018, 175 isocitrate-dehydrogenase-1 (IDH-1) wild-type glioblastoma patients underwent 5-ALA guided surgery. Patients’ data were retrospectively reviewed regarding demographics, comorbidities, medications, tumor morphology, neuropathological characteristics, and their association with intraoperative 5-ALA fluorescence. 5-ALA fluorescence was graded in a 3-point scaling system (grade 0 = no; grade 1 = weak; grade 2 = strong).
Results: Univariable analysis showed that the intake of dexamethasone or AEDs, and larger preoperative tumor areas significantly reduced the intraoperative fluorescence activity (Fluorescence grades: 0+1). Twenty-six (78.8%) out of 33 patients with either no or only weak fluorescence grades (grades 0+1) took antiepileptic drugs prior to surgery, whereas only 7 (22.2%) patients with fluorescence grades 0 or 1 had no AEDs in their preoperative medication (Fisher´s exact test (two-sided): p = 0.001). Multivariable binary logistic regression analysis demonstrated the preoperative intake of AEDs (adjusted odds ratio: 14.71, 95% confidence interval: 4.65-46.58, p = 0.001) as the only independent and significant risk factor for reduced fluorescence quality (Fluorescence grades: 0+1).
Conclusion: Preoperative antiepileptic drugs seem to significantly reduce intraoperative fluorescence. Indication for AEDs in suspected GB might be carefully reviewed and prophylactic treatment should be avoided in this tumor entity. Future comparative trials of neurosurgical fluorescent dyes might have a special focus on this endpoint. Further trials have to validate our findings.