Risk factors for developing oral 5-aminolevulinic acid-induced side effects in patients undergoing fluorescence guided resection

Abstract

Oral 5 aminolevulinic acid (5-ALA) is used to assist surgical resection of malignant tumours in the brain and other locations. Hypotension and alteration of liver functions have been reported as potential adverse effects. This study was designed to assess the incidence and contributing factors that cause 5-ALA induced side effects in a cohort of 90 patients. Hypotension occurred in 11% of patients irrespective of 5-ALA dose. The only contributing factor was the presence of cardiovascular disease and antihypertensive drug therapy with an odd ratio of 17.7. Liver function were disturbed in 2% in patients who received 20mg or less/kg body weight compared to 4% in those who received a dose of >20mg/kg 5-ALA. The liver dysfunction was minor and was not clinically significant. We concluded that 5-ALA induced side effects were minimal and hypotension more likely to occur in patients receiving antihypertensive drug therapy.

Keywords: 5 aminolevulinic acid 5-ALA; 5-ALA; 5-ALA fluorescence-guided resection group; 5-aminolevulinic acid (hydrochloride); AA; BMI; BMs; BP; CNS; Cancer; DBP; FBC; FIGR; FIGS; FL-group; GBM; Glioma; HCl; HGGs; HPLC; Hypotension; KPS; Karnofsky performance scale; LFTs; Liver functions; MAP; PBGD; PDT; PpIX; RFTs; RTOG-RPA; SBP; SPSS; Statistic Package for Social Sciences; Surgery; WL-group; anaplastic astrocytoma; blood pressure; body mass index; brain metastases; central nervous system; diastolic blood pressure; fluorescence image-guided surgery; full blood count; glioblastoma multiforme; high performance liquid chromatography; high-grade gliomas; liver function tests; mean arterial blood pressure; photodynamic therapy; porphobillnogen deaminase; protoporphyrin IX; radiation therapy oncology group recursive partitioning analysis; renal function tests; systolic blood pressure; white light resection group.