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Brain tumours kill more children and adults under the age of 40 than any other cancer

New NICE guidance advocates chemical dye to detect brain tumours

by Hugh Adams

Today, The National Institute for Health and Care Excellence (NICE) have issued new guidance for the treatment of brain tumour patients that make recommendations about diagnosis, monitoring and treatment, as well as the information and support that should be offered to patients. 

Consultant Neurosurgeon Professor Garth Cruickshank, the Chair of our Scientific and Medical Advisory Board (SMAB), who was involved as clinical lead in the production of these guidelines, told us, “This guideline, for the first time, provides the structure for treating patients with meningiomas and metastatic disease representing both the need for rapid access to care as well as the need for ongoing, even lifetime, support for those surviving with brain tumours.

Below, you can read the press release NICE issued this morning regarding these new guidelines;

"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 late Tessa Jowell, who passed away in May, urged the government to make 5-ALA available across the NHS in one of her final speeches to 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 to boost outcomes of people diagnosed with brain tumours.

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.

'Going through cancer treatment is a very difficult time in a person’s life and we want patients to have the highest quality care possible.

'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.

Professor Mark Baker, director for the centre for guidelines at NICE, said: 'The evidence examined by the committee shows using 5-ALA will improve tumour removal.

'This guidance and the roll out of 5-ALA – which we hope to see implemented in a timely manner at those units who don’t currently have access to it – will greatly improve patient experience.'

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.

'Plans to support and fund the roll-out of the dye to improve the precision surgery for high grade glioma patients are already well in place and this should more people get treated this way going forwards.