Main Session
Sep
27
PQA 01 - Gastrointestinal Cancer and Central Nervous System
2036 - Safety and Local Control of 5-Aminolevulinic Acid Fluorescence-Guided Surgery Combined with Cesium-131 Brachytherapy for Glioblastoma: A Matched-Pair Analysis
Presenter(s)
Michael Chodakiewitz, MD - Tufts Medical Center | Beth Israel Deaconess Medical Center, Boston, MA
M. Chodakiewitz1,2, R. Vega3, and L. M. Hertan4; 1Beth Israel Deaconess Medical Center - Department of Radiation Oncology, Boston, MA, 2Tufts Medical Center - Department of Radiation Oncology, Boston, MA, 3Beth Israel Deaconess Medical Center - Department of Neurosurgery, Boston, MA, 4Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA
Purpose/Objective(s):
Glioblastoma (GBM) frequently recurs within the surgical bed despite gross total resection (GTR). While 5-aminolevulinic acid (5-ALA) enhances resection through biological margin detection, and cesium-131 (Cs-131) brachytherapy provides immediate post-operative radiation, the safety of their combination is not well-characterized. We investigated the safety and local control of this dual-modality approach.Materials/Methods:
We performed a retrospective matched-pair analysis using the GTM-101 registry. Stringent inclusion criteria were applied: pathologically confirmed Glioblastoma, verified Complete GTR (100%), = 1 month of follow-up, and availability of complete operative reports. 5-ALA+ patients (N=14) were matched to controls (N=34) based on disease status (Newly Diagnosed vs. Recurrent). Intraoperative use of 5-ALA was confirmed by reviewing individual surgical records.Results:
A total of 48 patients with confirmed documentation were analyzed. Median follow-up was 6.98 months (5-ALA+) and 6.12 months (control). In this population of complete macroscopic resections, the addition of 5-ALA was associated with a nearly four-fold reduction in Surgical Bed Recurrence (SBR) compared to the control group (7.1% vs. 26.5%). Grade 3+ Adverse Events occurred in 28.6% (5-ALA+) vs. 23.5% (control). No cases of radiation necrosis were identified in either cohort.Conclusion:
These results suggest a potential synergistic effect between 5-ALA-guided cytoreduction and Cesium-131 intraoperative brachytherapy in the Glioblastoma cohort. While the observed reduction in local recurrence is promising, further study is required to validate these findings in a larger, prospective investigation.