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Photodynamic diagnosis with 5‐aminolevulinic acid for intraoperative detection of peritoneal metastases of ovarian cancer: A feasibility and dose finding study
Author(s) -
Hillemanns Peter,
Wimberger Pauline,
Reif Jessica,
Stepp Herbert,
Klapdor Rüdiger
Publication year - 2017
Publication title -
lasers in surgery and medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.888
H-Index - 112
eISSN - 1096-9101
pISSN - 0196-8092
DOI - 10.1002/lsm.22613
Subject(s) - medicine , prospective cohort study , ovarian cancer , protoporphyrin ix , adverse effect , cancer , protoporphyrin , stage (stratigraphy) , photodynamic therapy , gastroenterology , surgery , pathology , urology , paleontology , chemistry , porphyrin , organic chemistry , photochemistry , biology
Objective With a prospective feasibility study, we aimed to analyse the effect of different time points for application and dosage of preoperative oral 5‐aminolevulinic acid administration for photodynamic diagnosis of peritoneal metastases in ovarian cancer patients. Materials and Methods In this prospective cohort study patients were randomly divided into three different groups. 5‐Aminolevulinic acid was orally administered 3–14 hours before surgery using a dosage of 1 mg/kg, 4–9 hours using 10 mg/kg, and 9–16 hours using 10 mg/kg, respectively. Fluorescence was recorded intraoperatively using endoscopic equipment. The number and localization, of fluorescing nodules were documented. To analyze sensitivity and specificity samples from fluorescent and non‐fluorescent tissues were evaluated histologically. Plasma protoporphyrin concentrations as well as any adverse events were assessed perioperatively. Results In total, 26 patients suspected for ovarian cancer underwent intraoperative photodynamic diagnosis with 5‐aminolevulinic acid. Most of them suffered from advanced cancer, 72% from FIGO‐Stage IIIc. No severe adverse events were observed. Orally applied 5‐aminolevulinic acid with a dosage of 1 mg/kg revealed no detectable fluorescence. However, at a dosage of 10 mg/kg fluorescence of metastatic tissue was significantly stronger than of non‐affected tissue. If administered 4–9 hours preoperatively best detection rates for peritoneal metastases were obtained resulting in a sensitivity of 75% and a specificity of 100%. Conclusions Photodynamic diagnosis with 5‐aminolevulinic acid leads to safe and specific fluorescence detection of peritoneal metastases. 5‐Aminolevulinic acid should be used at a dosage of at least 10 mg/kg 4–9 hours preoperatively. Further phase I–II studies are recommended. Lasers Surg. Med. 49:169–176, 2017. © 2016 Wiley Periodicals, Inc.