NICE: more people to get 5-ALA dye to detect brain tumours

Images of scientists working in a head showing link between dementia and spontaneous errors in DNA

5-ALA, a chemical dye, which can assist neurosurgeons in the successful removal of a brain tumour should be used in initial surgery, NICE has said in final guidance.

Patients take 5-amino levulinic acid (5-ALA) – known as the pink drink – prior to surgery and as a result tumour cells glow pink under ultra violet light. A surgeon using a nonstandard fluorescence-detecting microscope is better able to identify which areas of the brain are cancerous and which are healthy.

“The roll out of 5-ALA will see more patients treated to a gold standard level of care and will help delay the recurrence of brain tumours.”

Tessa Jowell, who passed away in May, urged the government to make 5-ALA available across the NHS in the House of Lords. Prime Minister Theresa May announced in May £40m of government funding topped up by £25m from Cancer Research UK for the Tessa Jowell Brain Cancer Mission to stimulate innovative new research and clinical practice.

Each of England’s 27 neurosurgical units is expected to have an average of around 55 patients requiring 5-ALA per year. This is likely to cost the NHS between £1m-5m a year.
An estimated 11,000 people are diagnosed with a brain tumour each year in the UK and about a third of these would benefit from this new technology.

Symptoms of brain tumours are varied but could include headaches, changes in vision, seizures, nausea, drowsiness or impairment of normal brain function.

The new NICE guideline makes recommendations about diagnosis, monitoring and treatment as well as the information and support that should be offered to patients. These include people with malignant brain tumours, gliomas and metastases but also for those with more long term problematic tumours such as meningiomas.

Final recommendations include:
• Use targeted radiotherapy to reduce the risk of damage to the rest of the brain.
• Encourage referral to neurological rehabilitation assessment of physical, cognitive, and emotional function during all stages of treatment.
• The NHS should not offer tumour treating fields (TTF) as part of management of recurrent high-grade glioma because they are not cost effective.

Tom Roques, a consultant clinical oncologist at Norfolk and Norwich University Hospital NHS Foundation Trust and chair of the NICE committee, said: “People with brain tumours will see great benefits when these NICE guidelines are implemented. The roll out of 5-ALA will see more patients treated to a gold standard level of care and will help delay the recurrence of brain tumours.”

Cally Palmer, NHS England’s national cancer director, said: “NHS England is firmly committed to making 5-ALA universally available for all eligible patients in neuroscience centres across the country.”