However, the pathological results failed to produce any evidence of a metastasis. The twelve remaining patients were initially included because of a prior medical history of cnacer. Results of the biopsies showed small cell lung cancer in n = 2, melanoma in n = 2, breast cancer in n = 1, hepatic neoplasia in n = 1 case. The tumors in the biopsy group were located in the central region in n = 5, frontal lobe in n = 5, parietal lobe in n = 2, temporal lobe in n = 1, occipital lobe in n = 1, and cerebellum in n = 4 cases. The decision to perform biopsy was taken in eighteen patients: 12/18 because of eloquence and 6/18 because of tumor dissemination. The aim of the current study was to compare survival and local recurrence in a cohort of patients who underwent surgery for brain metastases with 5-ALA fluorescence microscopy to one that was operated using microscopic white light only. Thus, the utility and importance of using methods to improve local control of brain metastases remains an unresolved issue. This observation failed to reach statistical significance and did not translate into better overall survival. Local recurrence rates were reportedly lower when surgeons were guided by positive fluorescence intraoperatively (5-ALA positive: 7% vs. Others, however, reported lower rates of positive intraoperative fluorescence. ![]() In a series of 52 patients, Kamp and colleagues detected positive fluorescence in 62% of resected cerebral metastases. in 2007 and recently confirmed histologically in the peritumoral zone by our group. 5-ALA-uptake in cerebral metastases was first described by Utsuki et al. Its aim is to prolong progression-free survival through radical resection and improved local tumor control. ĥ-aminolevulinic acid (5-ALA) is widely used to guide resection of high-grade gliomas. Another group made the case for extending tumor resection 5 millimeters into peritumoral tissue to perform a so-called supramarginal resection. In a bid to improve local control, two surgical strategies have been advocated: One group suggested that en bloc-resection was superior to piecemeal. Radiotherapy and surgical lesion removal are the mainstay of treatment. Cerebral dissemination is the most common cause of tumor-related death. Ten to 40% of cancer patients are eventually affected, equaling about 150,000 patients in Europe every year. Metastatic brain disease is more common than primary brain tumors. The most prominent predictors of survival remain favorable preoperative performance status, a low tumor diameter and the absence of multiple cerebral lesions. The use of 5-ALA influenced neither in-brain recurrence (OR 0.59, p = 0.40) nor mortality (OR 0.71, p = 0.49).Ĭonclusions: The use of 5-ALA did not result in lower in-brain recurrence or mortality compared to the use of white light microscopy. Local in-brain recurrence occurred in 21/175 patients (12%) with a rate of 15/119 (12.6%) in the white light and 6/56 (10.7%) in the 5-ALA group ( p = 0.720). All baseline parameters were similarly distributed with no significant difference between surgical groups. Results: N = 175 patients were included in the study. In-brain recurrence and mortality were compared between groups. In the 5-ALA group, fluorescence guided peritumoral resection was additionally performed after standard microscopic resection. Two groups were compared: In the “white light” group, resection was performed with conventional microscopy. Materials and Methods: We included consecutive patients who underwent surgical resection of brain metastases. ![]() The aim of the present study is to assess whether the use of 5-ALA has an impact on local recurrence or survival compared to conventional white light microscopic tumor resection. ![]() Previous studies achieved a reduction of local recurrence rates by aggressively resecting the peritumoral zone (supramarginal resection) or using 5-aminolaevulinic acid (5-ALA) fluorescence. ![]() Keywords: brain tumor brain metastasis fluorescence-guided surgery 5-ALAīackground: Metastatic brain disease continues to have a dismal prognosis. * These authors share senior authorship equally 1 Department of Neurosurgery, University of Medicine Goettingen, Goettingen, GermanyĢ Department of Hematology-Oncology, University of Medicine Goettingen, Goettingen, Germanyģ Institute of Neuropathology, University of Medicine Goettingen, Goettingen, GermanyĤ Department of Neuropathology, University Medical Center Leipzig, Leipzig, Germanyĥ Department of Medicine A, University Hospital Muenster, Muenster, Germany
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