Does 5-ALA Fluorescence Microscopy Improve Complete Resectability in Cerebral/Cerebellar Metastatic Surgery? A Retrospective Data Analysis from a Cranial Center

被引：1

作者：

Sarkis, Hraq Mourad ^{[1
,2
,3
]}

Alsofy, Samer Zawy ^{[1
,2
]}

Stroop, Ralf ^{[1
]}

Lewitz, Marc ^{[1
,2
]}

Schipmann, Stephanie ^{[4
]}

Unnewehr, Markus ^{[1
]}

Paulus, Werner ^{[5
]}

Nakamura, Makoto ^{[6
]}

Ewelt, Christian ^{[2
]}

机构：

[1] Witten Herdecke Univ, Fac Hlth, Dept Med, D-58448 Witten, Germany

[2] Univ Munster, St Barbara Hosp, Acad Hosp Westfael Wilhelms, Dept Neurosurg, D-59073 Hamm, Germany

[3] Hannover Med Sch, St Marien Hosp, Acad Hosp, Dept Neurosurg, D-49076 Osnabruck, Germany

[4] Univ Hosp Muenster, Dept Neurosurg, D-48149 Munster, Germany

[5] Univ Hosp Muenster, Inst Neuropathol, D-48149 Munster, Germany

[6] Witten Herdecke Univ, Acad Hosp Koeln Merheim, Dept Neurosurg, D-51109 Cologne, Germany

来源：

CANCERS | 2024年 / 16卷 / 12期

关键词：

5-aminolevulinic acid (5-ALA); fluorescence; metastatic brain tumors; malignant gliomas; protoporphyrin IX; 5-AMINOLEVULINIC ACID; BRAIN METASTASES; PROTOPORPHYRIN-IX; LOCAL RECURRENCE; DIAGNOSIS; RESECTION; CANCER; EPIDEMIOLOGY; MANAGEMENT; LESIONS;

D O I：

10.3390/cancers16122242

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Simple Summary In the present study, the intraoperative fluorescence of brain metastases after the administration of 5-aminolevulinic acid (5-ALA) is investigated in 80 cases. Brain metastases fluoresced in 57.5% of cases, with no significant correlation between fluorescence and primary tumor or histological subtype. Complete resection of brain metastases was detected in 82.5%, of which 56.1% were fluorescence positive, compared to 43.9% which were non-fluorescent. Thus, prior administration of 5-ALA tended to improve the resectability rate by 12.1%. Fluorescence-positive and -negative metastases showed significantly different overall survival in this study. Therefore, administration of 5-ALA as a surgical adjuvant may be beneficial in resecting brain metastases and may potentially optimize the surgical procedure.Abstract (1) Background: In this study, the intraoperative fluorescence behavior of brain metastases after the administration of 5-aminolevulinic acid (5-ALA) was analyzed. The aim was to investigate whether the resection of brain metastases using 5-ALA fluorescence also leads to a more complete resections and thus to a prolongation of survival; (2) Methods: The following variables have been considered: age, sex, number of metastases, localization, involvement of eloquent area, correlation between fluorescence and primary tumor/subtype, resection, and survival time. The influence on the degree of resection was determined with a control MRI within the first three postoperative days; (3) Results: Brain metastases fluoresced in 57.5% of cases. The highest fluorescence rates of 73.3% were found in breast carcinoma metastases and the histologic subtype adenocarcinoma (68.1%). No correlation between fluorescence behavior and localization, primary tumor, or histological subtype was found. Complete resection was detected in 82.5%, of which 56.1% were fluorescence positive. There was a trend towards improved resectability (increase of 12.1%) and a significantly longer survival time (p = 0.009) in the fluorescence-positive group; (4) Conclusions: 5-ALA-assisted extirpation leads to a more complete resection and longer survival and can therefore represent a low-risk addition to modern surgery for brain metastases.

引用

页数：18