A high-tech ‘pink drink’, swallowed hours before surgery, is helping surgeons spot aggressive brain cancers, by making tumours glow in the dark.
The innovation, now being used by neurosurgeons across the UK, doubles the chances doctors will find – and remove – all the cancer, halting progression of the disease.
The drink, called Gliolan or ‘5-ALA’, uses a dye that reacts with a compound in the cancer which glows a pinkish colour when an ultraviolet light is shone on it, helping surgeons tell diseased tissue from healthy areas.
Surgeons rely on 3D scans of the brain and microscopes during surgery to find the disease. But as healthy tissue often becomes entangled with these fast-growing tumours, called glioblastomas, many patients end up with severe speech or movement problems following the operation as healthy tissue can be disturbed.
Dr Yasir Chowdhury, specialty registrar of neurosurgery at University Hospitals Birmingham, is one of those using the new method.
He says: ‘The drink highlights hard-to-see areas of tumour that are difficult to spot via other methods and may be missed.’
Funding for the technique was campaigned for by late Labour MP Tessa Jowell, who died in 2018 after suffering an aggressive glioblastoma. Of the 2,000 Britons diagnosed with such tumours every year, only a quarter survive more than a year.
While the pink drink won’t stop the cancer returning, Dr Chowdhury estimates it can help give patients an extra six months to a year, and improves quality of life in the short time they have remaining. The drink is one component of a more aggressive approach being taken to brain surgery.
Another example is ‘awake’ brain surgery, where the patient is kept awake during the procedure to monitor their reaction when parts of the brain are manipulated.
One patient who swallowed the ‘bittertasting’ drink before surgery to remove a tumour from the left side of his brain is Robert Binnersley, 75, from Hereford.
The dental surgeon had awake brain surgery earlier this month, following struggles with word comprehension. He took 50ml of the drink – a white powder mixed with water – two hours before his operation.
Detailed scans, such as MRI and CT, were conducted before the drink was given to help guide the surgery. In theatre, a reduced dose of general anaesthetic was given to make Mr Binnersley unconscious for the start of his operation.
Roughly two hours into surgery, the anaesthetic wore off slightly, leaving him awake but sedated enough so he couldn’t feel anything.
A UV light was held over the exposed brain, causing the cancerous tissue – nestled within the area governing speech – to glow pink.
Dr Athanasios Zisakis, Neuro-Oncology Fellow, performed the surgery. He asked Mr Binnersley a number of questions while prodding the tumour with instruments and monitored the effect on his pronunciation.
When simulating one area, he became unable to speak. This section was left intact while the remainder of the cancer – 80 per cent – was removed in a fourhour procedure.
Mr Binnersley, who spent just a night in hospital, said: ‘Conversations are still difficult sometimes. But I’ve been told some of this is due to the swelling from the surgery, and will improve over time.’
Dr Zisakis says the pink drink helped remove as much tumour as possible safely. He says: ‘The operation will have prolonged his life as long as possible while preserving the abilities that these patients are so often forced to forfeit.’