Article
5-ALA-induced fluorescence in cerebral metastases
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Authors
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Marcel A. Kamp
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Marion Rapp
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Hans-Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Michael Sabel
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: Standard surgical treatment of cerebral metastases consists in circumferential stripping of the tumor from the tumor-brain interface, assuming that thereby a gross total resection can be achieved. Intraoperative detection of residual malignant glioma by 5-aminolevulinic acid (ALA)-induced fluorescence (5-AIF) improves the rate of complete resections. Aim of the present study was to analyze incidence of 5-ALA-induced fluorescence in cerebral metastases.
Method: A retrospective analysis was performed for 120 patients who underwent 5-AIF-guided surgery of a cerebral metastasis. The dichotomized presence or absence of ALA-fluorescence was documented for all metastases. Data were correlated to clinical data, the results of the histopathological analysis and primary site. A subset of 90 patients had complete data sets including an early postoperative MRI < 72h and a follow-up > 1 year.
Results: Intraoperatively, 57/120 patients (47.5%) showed ADF, whereas 63 were ALA-negative (47.5%). 74% of patients suffered from an adenocarcinoma. A non-small cell lung cancer (NSCLC) could be identified as primary tumor in 58.2%, breast cancer in 15% and a malignant melanoma 5% of patients. 5-AIF was neither associated with the histological type nor with the site of origin of the metastases (p = .45; p = .88). For the subset of 90 patients, 5-AIF did not correlate with the occurrence of residual tumor in the MRI < 72h (p = .30; 1-sided Fisher's exact test) but with local in-brain-progression (p = .038).
Conclusions: About half of cerebral metastases exhibit 5-AIF in the present series. Absence of 5-AIF was a risk factor for local in-brain-progression in the present series as 23% of ALA-positive metastases showed a local recurrence compared to 43% of ALA-negative lesions. However, the further impact of 5-AIF in metastases surgery should be analyzed in future studies.
