10 July 2018

More people to be given dye to highlight brain tumours to surgeons say NICE

Hundreds of patients a year set to benefit from roll out of dye to all of England’s neurosurgical units

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 published guidance, it is recommended patients take 5-amino levulinic acid (5-ALA) - known as the pink drink – prior to surgery.

As a result tumour cells glow pink under ultra violet light allowing a surgeon using a fluorescence-detecting microscope to better identify which areas of the brain are cancerous and which are healthy.

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.

The late Dame Tessa Jowell 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.

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 of 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 mean more people get treated this way going forwards."

An estimated 11,000 people are diagnosed with a brain tumour each year in the UK.

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 not only for people with malignant brain tumours, gliomas and metastases but also for those with more long term problematic tumours such as meningiomas.

The guideline includes recommendations which would see are more targeted use radiotherapy and referral of patients to neurological rehabilitation during all stages of treatment.

People with brain tumours will see great benefits when these NICE guidelines are implemented.

Dr Tom Roques, chair of the NICE committee

The evidence examined by the committee shows using 5-ALA will improve tumour removal.

Professor Mark Baker, director for the centre of guidelines at NICE

NHS England is firmly committed to making 5-ALA universally available for all eligible patients.

Cally Palmer, NHS England's national cancer director