5-Aminolevulinic Acid Fluorescence-Guided Surgery in Head and Neck Squamous Cell Carcinoma
Corresponding Author
Peter Filip MD
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Send correspondence to Peter Filip, Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, Annenberg 10th Floor, 1 Gustave L. Levy Place, New York, NY 10029. Email: [email protected]
Search for more papers by this authorDavid K. Lerner MD
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorEvan Kominsky BA
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorAlexander Schupper MD
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorKatherine Liu MD
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorNazir Mohemmed Khan MD
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorScott Roof MD
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorConstantinos Hadjipanayis MD
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorEric Genden MD
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorAlfred M. C. Iloreta MD
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorCorresponding Author
Peter Filip MD
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Send correspondence to Peter Filip, Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, Annenberg 10th Floor, 1 Gustave L. Levy Place, New York, NY 10029. Email: [email protected]
Search for more papers by this authorDavid K. Lerner MD
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorEvan Kominsky BA
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorAlexander Schupper MD
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorKatherine Liu MD
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorNazir Mohemmed Khan MD
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorScott Roof MD
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorConstantinos Hadjipanayis MD
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorEric Genden MD
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorAlfred M. C. Iloreta MD
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.
Search for more papers by this authorThe authors have no other funding, financial relationships, or conflicts of interest to disclose.
Abstract
Objectives
To determine the utility of 5-aminolevulinic acid (5-ALA) fluorescence for resection of head and neck carcinoma.
Methods
In this prospective pilot trial, 5-ALA was administered as an oral suspension 3–5 h prior to induction of anesthesia for resection of head and neck squamous cell carcinoma (HNSCC). Following resection, 405 nm blue light was applied, and fluorescence of the tumor as well as the surgical bed was recorded. Specimen fluorescence intensity was graded categorically as none (score = 0), mild (1), moderate (2), or robust (3) by the operating surgeon intraoperatively and corroborated with final pathologic diagnosis.
Results
Seven patients underwent resection with 5-ALA. Five (83%) were male with an age range of 33–82 years (mean = 60). Sites included nasal cavity (n = 3), oral cavity (n = 3), and the larynx (n = 1). All specimens demonstrated robust fluorescence when 5-ALA was administered 3–5 h preoperatively. 5-ALA fluorescence predicted the presence of perineural invasion, a positive margin, and metastatic lymphadenopathy. Two patients had acute photosensitivity reactions, and one patient had a temporary elevation of hepatic enzymes.
Conclusions
5-ALA induces robust intraoperative fluorescence of HNSCC, capable of demonstrating a positive margin, perineural invasion, and metastatic nodal disease. Although no conclusions are there about the safety of this drug in the head and neck cancer population, our study parallels the extensive safety data in the neurosurgical literature. Future applications may include intraoperative assessment of margin status, diagnostic accuracy, and impacts on survival.
Level of Evidence
4 Laryngoscope, 134:741–748, 2024
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