Brain metastases. Does fluorescent marking facilitate the surgical removal of tumors?

Physicians from Karl Landsteiner University of Health Sciences (KL Krems, Austria) present results of the world's most extensive study headed by the MedUni Vienna investigating the value of 5-aminolevulinic acid in surgery of brain metastases
By: Karl Landsteiner University of Health Sciences
KREMS, Austria - May 19, 2020 - PRLog -- Two-thirds of brain metastases give off fluorescence following administration of 5-aminolevulinic acid, which could potentially assist surgeons in identifying such tumors. However, fluorescence patterns are often heterogeneous or vague, which limits their practical benefits. These were the key findings of a major study performed by Karl Landsteiner University of Health Sciences in Krems (KL Krems) and headed by the Medical University of Vienna, published in the Journal of Neurosurgery. The study looked at 150 patients, making this the world's most comprehensive research project of its kind to date. It has also delivered significant results, which will form a valuable basis for developing this potentially useful technique.

Brain metastases are the most common type of tumor that affects the brain, occurring in 20-40 percent of all systemic cancers. They are often removed surgically, which is an important treatment option aside from radiotherapy, gamma knife radiosurgery or chemotherapy. In most cases, they can be effectively removed, as metastases can often be clearly distinguished from the surrounding tissue. However, recent research found that residual tumors remain after around 20 percent of surgical resections. Performing an operation after administering 5-aminolevulinic acid (5-ALA) could enable surgeons to pinpoint these hard-to-visualize parts of tumors during surgery. Particularly in tumor cells, 5-ALA creates easily recognizable fluorescence, which in turn simplifies identification of residual tumors. This already is an established method of treating primary brain tumors, but so far there has been no systematic investigation of its use in connection with brain metastases. This was what the team from KL Krems and MedUni Vienna set out to achieve in the largest study of its kind to be performed anywhere in the world – and their findings were sobering.

Original Publication: Detailed analysis of 5-aminolevulinic acid induced fluorescence in different brain metastases at two specialized neurosurgical centers: experience in 157 cases. F. Marhold, P.A. Mercea, F. Scheichel, A.S. Berghoff, P. Heicappell, B. Kiesel, M. Mischkulnig, M. Borkovec, S. Wolfsberger, A. Woehrer, M. Preusser, E. Knosp, K. Ungersboeck, G. Widhalm. J Neurosurg. doi: 10.3171/2019.6.JNS1997.

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