Article
5-Aminolevulinic acid fluorescence indicates cerebral tumor invasion in brain metastasis
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Authors
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Florian Stockhammer
- Klinik für Neurochirurgie
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Tobias Pukrop
- Klinik für Hämatologie und Onkologie
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Alonso Barrantes-Freer
- Institut für Neuropathologie, Universitätsmedizin Göttingen
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Veit Rohde
- Klinik für Neurochirurgie
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Laila Siam
- Klinik für Neurochirurgie
| Published: | June 2, 2015 |
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Outline
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Objective: In glioma surgery 5-aminolevulinic acid (5-ALA) fluorescence is indicative of tumor invasion and fluorescence-assisted resection correlates with improved progression free survival. Recent studies report that brain metastases exhibit considerable peritumoral invasion, which is dependent on primary tumor type, and questions effect of surgical removal without adjuvant treatment. However, whether 5-ALA fluorescence also indicates the extent of metastasis invasion in the adjacent brain parenchyma remains unknown. In the present work we performed fluorescence-assisted metastasis removal with subsequent histological analysis of surrounding brain tissue in a cohort of 20 patients.
Method: A total of 20 patients with brain metastasis from 4 different primary tumor types underwent fluorescence-assisted resection of the cerebral metastasis. Patients received 20mg/kg 5-ALA three hours before anesthesia. Intraoperatively, biopsies of tumor and surrounding brain parenchyma followed the assessment of the fluorescence status of the tissue. Further, the specimens of perilesional areas were immunostained and screened for infiltrating tumor cells.
Results: The primary tumors were divided in four tumor types with the following frequencies: small cell lung cancer (SCLC) in 4, non-SCLC in 7, breast cancer in 5 and melanoma in 3 patients. One patient had cancer with unknown primary (CUP). Thirteen patients revealed fluorescence of surrounding tissue and infiltrating tumor cells in the surrounding brain tissue. Three patients had tumor cell infiltration without fluorescence. A total of four patients (melanoma, non-SCLC and breast cancer in two patients) had neither infiltration nor fluorescence of surrounding tissue. Fluorescence correlated with tumor infiltration (p=.0072, fisher's exact test) resulting in a sensitivity of .81 (95% CI .54-.96) and specificity of 1.0 (.40-1).
Conclusions: Cerebral invasion is a common finding in brain metastasis in selected primary tumors. 5-ALA fluorescence correlates with tumor cell invasion.
