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. 2023 Mar;162(1):217-223.
doi: 10.1007/s11060-023-04284-9. Epub 2023 Mar 16.

Interstitial photodynamic therapy for newly diagnosed glioblastoma

Stefanie Quach  1 , Christoph Schwartz  1   2 , Maximilian Aumiller  3   4 , Marco Foglar  3   4 , Michael Schmutzer  1 , Sophie Katzendobler  1 , Mohamed El Fahim  3   4 , Robert Forbrig  5 , Katja Bochmann  6 , Rupert Egensperger  7 , Ronald Sroka  3   4 , Herbert Stepp  3   4 , Adrian Rühm  3   4 , Niklas Thon  8   9
Affiliations

Interstitial photodynamic therapy for newly diagnosed glioblastoma

Stefanie Quach et al. J Neurooncol. 2023 Mar.

Abstract

Purpose: Innovative, efficient treatments are desperately needed for people with glioblastoma (GBM).

Methods: Sixteen patients (median age 65.8 years) with newly diagnosed, small-sized, not safely resectable supratentorial GBM underwent interstitial photodynamic therapy (iPDT) as upfront eradicating local therapy followed by standard chemoradiation. 5-aminolevulinic acid (5-ALA) induced protoporphyrin IX was used as the photosensitizer. The tumors were irradiated with light at 635 nm wavelength via stereotactically implanted cylindrical diffuser fibers. Outcome after iPDT was retrospectively compared with a positively-selected in-house patient cohort (n = 110) who underwent complete tumor resection followed by chemoradiation.

Results: Median progression-free survival (PFS) was 16.4 months, and median overall survival (OS) was 28.0 months. Seven patients (43.8%) experienced long-term PFS > 24 months. Median follow-up was 113.9 months for the survivors. Univariate regression revealed MGMT-promoter methylation but not age as a prognostic factor for both OS (p = 0.04 and p = 0.07) and PFS (p = 0.04 and p = 0.67). Permanent iPDT-associated morbidity was seen in one iPDT patient (6.3%). Patients treated with iPDT experienced superior PFS and OS compared to patients who underwent complete tumor removal (p < 0.01 and p = 0.01, respectively). The rate of long-term PFS was higher in iPDT-treated patients (43.8% vs. 8.9%, p < 0.01).

Conclusion: iPDT is a feasible treatment concept and might be associated with long-term PFS in a subgroup of GBM patients, potentially via induction of so far unknown immunological tumor-controlling processes.

Keywords: 5-aminolevulinic acid; Glioblastoma; Interstitial photodynamic therapy; Overall survival; Postoperative morbidity; Progression-free survival.

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Conflict of interest statement

Stefanie Quach - No disclosures. Christoph Schwartz - No disclosures. Maximilian Aumiller - No disclosures. Marco Foglar - No disclosures. Michael Schmutzer - No disclosures. Sophie Katzendobler - No disclosures. Mohamed El Fahim - No disclosures. Robert Forbrig - No disclosures. Katja Bochmann - No disclosures. Rubert Egensperger - No disclosures. Ronald Sroka - No disclosures. Herbert Stepp - No disclosures. Adrian Rühm - No disclosures. Niklas Thon - No disclosures.

Figures

Fig. 1
Fig. 1
Exemplary case illustrating three-dimensional planning of the light diffusor trajectories. The patient (IPDT 02) presented with seizures and aphasia leading to the diagnosis of glioblastoma in the left angular gyrus
Fig. 2
Fig. 2
Progression-free survival and overall survival were significantly longer in the interstitial photodynamic therapy (iPDT) cohort compared to the reference cohort
See this image and copyright information in PMC

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