Li Xuegang, Feng Hua, Li Fei
Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing 400038, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2018 Apr 28;43(4):360-367. doi: 10.11817/j.issn.1672-7347.2018.04.005.
The prognosis of glioma remains poor because of the infiltrative nature and the high local relapse rate. The current goals for patients with gliomas is maximal safe resection and adjuvant therapy. Tumor-specific photosensitizer, such as hematoporphyrin derivative (HpD) 5-aminolevulinic acid (5-ALA), can be selective up-taken and accumulated in tumor tissue. Light with appropriate wavelength can penetrate tumor tissue and excite the photosensitizer. The excited photosensitizer within glioma cells permits fluorescence visualization of tumor tissue during surgery and has been introduced in treatment of glioma as fluorescence-guided surgery (FGS). On the other hand, the toxicity of singlet oxygen generated by the excited photosensitizer has been used as photodynamic therapy (PDT) in selective destruction of the tumor. Some reports demonstrated the usefulness of adding PDT as an intraoperative adjuvant therapy, but the complexity associated with its implementation and the introduction of TMZ prevented PDT from becoming a routine therapy. However, FGS using 5-ALA in patients with malignant brain tumors has surfaced globally and may become a useful tool in increasing the extent of resection in gliomas.
由于胶质瘤具有浸润性本质和较高的局部复发率，其预后仍然很差。目前，胶质瘤患者的治疗目标是最大程度的安全切除和辅助治疗。肿瘤特异性光敏剂，如血卟啉衍生物（HpD）、5-氨基酮戊酸（5-ALA），可被肿瘤组织选择性摄取并积聚。适当波长的光可穿透肿瘤组织并激发光敏剂。胶质瘤细胞内被激发的光敏剂可使肿瘤组织在手术期间实现荧光可视化，并已作为荧光引导手术（FGS）应用于胶质瘤治疗。另一方面，被激发的光敏剂产生的单线态氧的毒性已被用作光动力疗法（PDT），用于选择性破坏肿瘤。一些报告证明了添加PDT作为术中辅助治疗的有效性，但与实施PDT相关的复杂性以及替莫唑胺（TMZ）的引入阻碍了PDT成为常规治疗方法。然而，在恶性脑肿瘤患者中使用5-ALA进行FGS已在全球范围内出现，并且可能成为增加胶质瘤切除范围的有用工具。
