5-ALA fluorescence of cerebral metastases and its impact for the local-in-brain progression.

Marcel A Kamp,Jan Frederick Cornelius,Igor Fischer,Hans-Jakob Steiger,Michael Sabel,Marion Rapp,Julia Bühner,Bernd Turowski,Philipp J Slotty

doi:10.18632/oncotarget.11488

Marcel A Kamp, Jan Frederick Cornelius + Show 7 more

Open Access

https://doi.org/10.18632/oncotarget.11488

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Journal: Oncotarget	Publication Date: Aug 22, 2016
Citations: 70	License type: cc-by

Affiliation: Heinrich Heine University Düsseldorf

Abstract

Aim of the present study was to analyze the oncological impact of 5-ALA fluorescence of cerebral metastases. A retrospective analysis was performed for 84 patients who underwent 5-ALA fluorescence-guided surgery of a cerebral metastasis. Dichotomized fluorescence behavior was correlated to the histopathological subtype and primary site of the metastases, the degree of surgical resection on an early postoperative MRI within 72 hours after surgery, the local in-brain-progression rate and the overall survival. 34/84 metastases (40.5%) showed either strong or faint and 50 metastases (59.5%) no 5-ALA derived fluorescence. Neither the primary site of the cerebral metastases nor their subtype correlated with fluorescence behavior. The dichotomized 5-ALA fluorescence (yes vs. no) had no statistical influence on the degree of surgical resection. Local in-brain progression within or at the border of the resection cavity was observed in 26 patients (30.9%). A significant correlation between 5-ALA fluorescence and local in-brain-progression rate was observed and patients with 5-ALA-negative metastases had a significant higher risk of local recurrence compared to patients with 5-ALA positive metastases. After exclusion of the 20 patients without any form of adjuvant radiation therapy, there was a trend towards a relation of the 5-ALA behavior on the local recurrence rate and the time to local recurrence, although results did not reach significance anymore. Absence of 5-ALA-induced fluorescence may be a risk factor for local in-brain-progression but did not influence the mean overall survival. Therefore, the dichotomized 5-ALA fluorescence pattern might be an indicator for a more aggressive tumor.

Highlights

Cerebral metastasis are the most common cerebral neoplasms and, for different reasons, the incidence is increasing [1]
84 patients suffering from cerebral metastatic spread were identified who underwent intraoperative 5-aminolevulinic acid (5-ALA) estimation during microsurgical resection of a cerebral metastasis. 46 patients were female, 38 male
Non-small cell lung cancer (NSCLC) could be identified as primary tumor in 44 patients, breast cancer in 11 patients, small-cell lung cancer (SCLC) or renal cancer in 6 patients each, carcinoma of unknown primary in 5 patients, malignant melanoma, carcinoma arising from the gastro-intestinal tract or the uro-genital tract in four patients each

Summary

Introduction

Cerebral metastasis are the most common cerebral neoplasms and, for different reasons, the incidence is increasing [1]. The surgical resection of single cerebral metastases is a key element in a multimodal therapeutic concept (level I evidence) [2,3,4,5]. The major goal is to achieve local tumor control by a complete sugical resection with low morbidity and mortality. Surgery alone is not sufficient to achieve local control in about 50% of patients [7,8,9]. An infiltrative growth pattern of cerebral metastases and small, unintended residual tumor parts even after intended gross-total tumor resection have been discussed as reasons for the high local recurrence rate [10,11,12,13,14,15]

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