How Coloring Brain Tumors Pink Can Help Cancer Patients Live Longer
June 10, 2019
When a surgeon removes a brain tumor, precision is everything: The goal is to remove as much of the cancerous tissue as possible, while preserving the surrounding brain tissue.
A drug called 5-aminolevulinic acid (5-ALA) can improve the ability of surgeons to do that. The drug makes brain tumor cells turn a bright pink when the surgeon exposes it under fluorescent light during surgery. This helps surgeons to see the edges of the tumor more clearly, allowing them to remove the cancerous tissue more completely and precisely.
The Importance of Precision
Several published studies, including those authored by Andrew Sloan, MD, Director, Brain Tumor and Neuro-Oncology Center at UH Seidman and UH Cleveland Medical Center, have shown that removing more tumor results in improved survival. However, removing the entire tumor can be difficult, even for the most experienced surgeons.
“Glioblastoma are tumors that derive from the brain itself,” Dr. Sloan says. “They look like brain tissue, they feel like brain tissue, and at times, it’s hard to determine where tumor ends and inflamed brain tissue begins.”
Using 5-ALA to turn the cancerous tissue bright pink can change all that. Patients take the drug by mouth before surgery. Then, during the surgery, Dr. Sloan uses a specially adapted surgical microscope that can illuminate the tumor with either white or blue light.
Improved Survival Rates
The outlook is often bleak for people with malignant gliomas, the most common – and most aggressive – type of primary brain cancer tumor: a median survival time of only about 14.5 months.
“Nearly 13,000 people in the United States are diagnosed each year with malignant gliomas,” Dr. Sloan says. “Unfortunately, cures are rare and most patients live less than two years, so improved treatment options are critical.”
Using 5-ALA allows the surgeon to visualize the tumor more precisely, which allows more extensive resection and improved survival.
“We know that if we get 95 percent or more of the tumor out, we essentially double survival for someone with a malignant glioma,” Dr. Sloan says.
Standard of Care
The Food and Drug Administration (FDA) approved 5-ALA for use in the United States in 2017. The drug has long been a standard of care in Germany and much of Europe.
Dr. Sloan has conducted clinical trials with 5-ALA for almost a decade based on his own FDA-approved clinical trial and was the first neurosurgeon in the United States to use the drug on a patient with brain cancer since the FDA approval.
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