P07.18.B 5-ALA SELF-ADMINISTRATION PRIOR TO GLIOMA SURGERY - A MONOCENTRIC FEASIBILITY STUDY

Abstract BACKGROUND Healthcare institutions are regularly admitting patients for surgical procedures on the same day, a concept known as same-day surgery. However, for 5-ALA fluorescence-guided surgery (FGS), the fluorescence agent is to be administered orally four hours prior to the induction of anesthesia. Also, patients are sensitized to light after administration of 5-ALA. Consequently, 5-ALA is typically administered within a hospital setting. This study investigated the feasibility of patient self-managed 5-ALA administration prior to glioma surgery. MATERIAL AND METHODS This prospective study included patients scheduled for FGS as the first surgical case on the day and who agreed on hospitalization for surgery on the day of surgery (same-day surgery). All patients received the appropriate dose of 5-ALA with oral and written instructions to use. All patients received an anonymous questionnaire to evaluate 5-ALA self-administration, focusing on medication handling, adherence to light protection measures and the incidence of adverse events. RESULTS Twenty-six (100%) patients were included from February 2024 until February 2025. Eleven patients (42%) had previously had 5-ALA for prior surgery. Two patients (8%) did not feel well-informed prior to self-managed 5-ALA administration and three patients (12%) had unresolved questions later regarding photosensitivity, possible side effects and the volume of water the powder had to be dissolved in. Two patients (8%) dissolved 5-ALA 15 minutes prior to intake and twenty-five patients (96%) immediately before intake. All patients (100%) took the medication on time (+/- 30 minutes). Four patients (15%) reported difficulties opening the vial. Twenty-one patients (81%) did not require assistance for the preparation of 5-ALA and five patients (19%) were assisted by family members or another person. All patients (100%) consumed the medication fully. Two patients (8%) reported nausea after administration, other adverse events were not reported. None of the patients presented with solar erythema. Twenty-four patients (92%) did not perceive photosensitivity as being problematic. Twenty-two patients (85%) did not perceive handling 5-ALA as more difficult than handling any other medication. CONCLUSION Our data demonstrate feasibility of patient-managed 5-ALA application prior to glioma surgery. Patients appear to be comfortable handling the medication, rarely requiring assistance. Protection from light after 5-ALA administration is not perceived as problematic by the patients, and no severe adverse events requiring medical attention occurred.