The Role of 5-Aminolevulinic Acid Fluorescence-Guided Surgery in Head and Neck Cancers: a Pilot Trial

  • STATUS
    Recruiting
  • End date
    Dec 10, 2022
  • participants needed
    23
  • sponsor
    Icahn School of Medicine at Mount Sinai
Updated on 10 November 2021
neutrophil count
primary cancer

Summary

This study allows head and neck cancer surgeons to specifically visualize cancerous cells apart from normal healthy tissue. 5-aminolevulinic acid (5-ALA) is a safe and effective FDA-approved agent successfully used by neurosurgeons for FGS of different brain tumors is given to the patients preoperatively. Using specific wavelengths of light as well as specialized magnified lenses the surgeons use this technique to assist in tumor resection.

Description

Treatment for many head and neck cancer involves surgical resection, or removal, of the tumor. A potential outcome of surgery is subtotal resection, in which some cancerous material fails to be removed resulting in tumor recurrence and lower overall survival. Achieving total resection without interfering with normal tissue is a challenge due the critical anatomical structures of the head and neck. Fluorescent-guided surgery (FGS) is a new method of intraoperative imaging that can be used to clearly visualize cancerous tissue aprt from normal tissue during surgery in real-time. Before surgery, an agent that preferentially enters tumor cells is given to the patient. Tumor cells then glow brightly when exposed to specific wavelengths of light during surgery, allowing the surgeon to easily distinguish between healthy and cancerous tissue. 5-aminolevulinic acid (5-ALA) is a safe and effective FDA approved agent successfully used by neurosurgeons for FGS of different brain tumors which has not been assessed for use in head and neck cancers. The aim of the study is to determine if 5-ALA can be effectively used in FGS for different types of head and neck cancers, and if it will improve survival, tumor regrowth, and other outcomes for patients. 23 patients will be enrolled from the Mount Sinai Hospital, New York Eye and Ear Infirmary and Mount Sinai Union Square Faculty Practices over a 1 year period and will be completed by December 2022.

Details
Condition Ewing's Family Tumors, Skull Base Neoplasms, Cancer, Cancer (Pediatric), Neoplasms, Cancer/Tumors
Treatment 5-Aminolevulinic acid Hydrochloride, 5-Aminolevulinic acid Hydrochloride
Clinical Study IdentifierNCT05101798
SponsorIcahn School of Medicine at Mount Sinai
Last Modified on10 November 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Subjects included in this trial must have had documentation of a new or recurrent head and neck or skull base tumor for which surgical resection is indicated and has been planned. These patients will include those with newly diagnosed or recurrent malignancies
Age 18-80
Karnofsky score >60%
Subjects must have normal organ and marrow function as defined below
leukocytes 3,000/mcL
absolute neutrophil count 1,500/mcL
platelets 100,000/mcl
total bilirubin within normal institutional limits
AST(SGOT)/ALT(SPGT) 2.5 X institutional upper limit of normal
creatinine within normal institutional limits OR Creatinine clearance >60 mL/min/1.73m2 for patients with creatinine levels above institutional normal as defined per institution
The effects of Gleolan (5-ALA) on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. A pregnancy test will be performed for all women of childbearing ability prior to surgery (see Exclusion Criteria below). Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
Ability to understand and the willingness to sign a written informed consent

Exclusion Criteria

Patients with non-resectable tumors or not deemed surgical candidates
History of allergic reactions attributed to compounds of similar chemical/biologic composition to ALA
Personal or family history of porphyria
Uncontrolled concurrent illness including but not limited to: ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness//social situations that would limit compliance with study requirements
Women who are pregnant or become pregnant will be excluded from the trial as it is unknown if ALA is teratogenic or has abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with 5-ALA breastfeeding should be discontinued if the mother is treated with 5-ALA
Prior history of GI perforation, diverticulitis, and or/peptic ulcer disease
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