{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:03:51Z","timestamp":1791518631282,"version":"4.3.4"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2017,4,1]],"date-time":"2017-04-01T00:00:00Z","timestamp":1491004800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NEUROSURGERY","NEUROS"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>BACKGROUND:<\/jats:bold>\n                    Five-aminolevulinic acid (5-ALA) is used for fluorescence-guided resections of malignant glioma at a dose of 20\u00a0mg\/kg; yet, it is unknown whether lower doses may also provide efficacy.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>OBJECTIVE:<\/jats:bold>\n                    To perform a double-blinded randomized study comparing 3 different doses of 5-ALA.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>METHODS:<\/jats:bold>\n                    Twenty-one patients with suspected malignant glioma were randomly assigned to 0.2, 2, or 20\u00a0mg\/kg 5-ALA. Investigators were unaware of dose. Intraoperatively, regions of interest were first defined in tumor core, margin, and adjacent white matter under white light. Under violet\u2013blue illumination, the surgeon's impression of fluorescence was recorded per region, followed by spectrometry and biopsy. Plasma was collected after administration and analyzed for 5-ALA and protoporphyrin IX (PPIX) content.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>RESULTS:<\/jats:bold>\n                    The positive predictive value of fluorescence was 100%. Visual and spectrometric fluorescence assessment showed 20\u00a0mg\/kg to elicit the strongest fluorescence in tumor core and margins, which correlated with cell density. Spectrometric and visual fluorescence correlated significantly. A 10-fold increase in 5-ALA dose (2-20\u00a0mg\/kg) resulted in a 4-fold increase of fluorescence contrast between marginal tumor and adjacent brain. t\n                    <jats:sub>max<\/jats:sub>\n                    for 5-ALA was 0.94 h for 20\u00a0mg\/kg (0.2 kg: 0.50 h, 2 mg\/kg: 0.61 h). Integrated PPIX plasma levels were 255.8 and 779.9 mcg*h\/l (2 vs 20\u00a0mg\/kg). Peak plasma concentrations were observed at 1.89 \u00b1 0.71 and 7.83 \u00b1 0.68 h (2 vs 20\u00a0mg\/kg; average \u00b1 Standard Error of Mean [SEM]).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>CONCLUSION:<\/jats:bold>\n                    The highest visible and measurable fluorescence was yielded by 20\u00a0mg\/kg. No fluorescence was elicited at 0.2 mg\/kg. Increasing 5-ALA doses did not result in proportional increases in tissue fluorescence or PPIX accumulation in plasma, indicating that doses higher than 20\u00a0mg\/kg will not elicit useful increases in fluorescence.\n                  <\/jats:p>","DOI":"10.1093\/neuros\/nyx074","type":"journal-article","created":{"date-parts":[[2017,3,25]],"date-time":"2017-03-25T02:30:46Z","timestamp":1490409046000},"page":"230-239","source":"Crossref","is-referenced-by-count":102,"title":["Randomized, Prospective Double-Blinded Study Comparing 3 Different Doses of 5-Aminolevulinic Acid for Fluorescence-Guided Resections of Malignant Gliomas"],"prefix":"10.1227","volume":"81","author":[{"given":"Walter","family":"Stummer","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert","family":"Stepp","sequence":"additional","affiliation":[{"name":"Laser-Research Laboratory, LIFE-Center at University Hospital of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otmar D.","family":"Wiestler","sequence":"additional","affiliation":[{"name":"German Cancer Research Center (DKFZ), Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Pichlmeier","sequence":"additional","affiliation":[{"name":"Medac GmbH, Gesellschaft f\u00fcr klinische Spezialpr\u00e4parate mbH, Wedel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,8]]},"reference":[{"issue":"6","key":"bib1-20231011","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1215\/15228517-2008-052","article-title":"Resection and survival in glioblastoma multiforme: an RTOG recursive partitioning analysis of ALA study patients","volume":"10","author":"Pichlmeier","year":"2008","journal-title":"Neuro Oncol."},{"issue":"3","key":"bib2-20231011","doi-asserted-by":"crossref","first-page":"595","DOI":"10.3171\/2010.2.JNS091322","article-title":"Coregistered fluorescence-enhanced tumor resection of malignant glioma: relationships between \u03b4-aminolevulinic acid-induced protoporphyrin IX fluorescence, magnetic resonance imaging enhancement, and neuropathological parameters. 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