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Schatlo B, Stockhammer F, Barrantes-Freer A, et al. 5-Aminolevulinic Acid Fluorescence Indicates Perilesional Brain Infiltration in Brain Metastases. World Neurosurg X. 2019;5:100069doi: 10.1016/j.wnsx.2019.100069.
Schatlo, B., Stockhammer, F., Barrantes-Freer, A., Bleckmann, A., Siam, L., Pukrop, T., & Rohde, V. (2020). 5-Aminolevulinic Acid Fluorescence Indicates Perilesional Brain Infiltration in Brain Metastases. World neurosurgery: X, 5100069. https://doi.org/10.1016/j.wnsx.2019.100069
Schatlo, Bawarjan, et al. "5-Aminolevulinic Acid Fluorescence Indicates Perilesional Brain Infiltration in Brain Metastases." World neurosurgery: X vol. 5 (2020): 100069. doi: https://doi.org/10.1016/j.wnsx.2019.100069
Schatlo B, Stockhammer F, Barrantes-Freer A, Bleckmann A, Siam L, Pukrop T, Rohde V. 5-Aminolevulinic Acid Fluorescence Indicates Perilesional Brain Infiltration in Brain Metastases. World Neurosurg X. 2019 Dec 16;5:100069. doi: 10.1016/j.wnsx.2019.100069. eCollection 2020 Jan. PMID: 32095783; PMCID: PMC7026613.
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World Neurosurg X. 2019 Dec 16;5:100069. doi: 10.1016/j.wnsx.2019.100069. eCollection 2020 Jan.

5-Aminolevulinic Acid Fluorescence Indicates Perilesional Brain Infiltration in Brain Metastases.

World neurosurgery: X

Bawarjan Schatlo, Florian Stockhammer, Alonso Barrantes-Freer, Annalen Bleckmann, Laila Siam, Tobias Pukrop, Veit Rohde

Affiliations

  1. Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University of Göttingen, Göttingen, Germany.
  2. Department of Neurosurgery, Municipal Hospital Dresden, Dresden, Germany.
  3. Institute of Neuropathology, University Medical Center Göttingen, Georg-August-University of Göttingen, Göttingen, Germany.
  4. Department of Hematology/Medical Oncology, University Medical Center Göttingen, Georg-August-University of Göttingen, Göttingen, Germany.
  5. Department of Medicine A, University Hospital Muenster, Muenster, Germany.
  6. Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.

PMID: 32095783 PMCID: PMC7026613 DOI: 10.1016/j.wnsx.2019.100069

Abstract

BACKGROUND: In glioma surgery, 5-aminolevulinic acid (5-ALA) fluorescence reflects tumor infiltration, and fluorescence-assisted resection correlates with higher removal rates and improved progression-free survival. Recent studies report that a sizable proportion of brain metastases exhibit peritumoral infiltration on the cellular level. There is little information regarding whether 5-ALA is useful to guide surgery in the peritumoral zone in metastases. The aim of this study was to assess histologically whether 5-ALA fluorescence accurately reflects metastatic brain infiltration.

METHODS AND MATERIALS: Fluorescence-assisted tumor resection was performed in 27 patients with brain metastases. Patients received 20 mg/kg 5-ALA 3 hours before anesthesia. After resection, biopsy specimens of the surrounding parenchyma were analyzed for 5-ALA fluorescence and histologic evidence of infiltrating tumor cells. The correlation between 5-ALA positivity and immunohistochemical evidence of tumor in the peritumoral zone was also assessed.

RESULTS: Of 27 metastases, 23 (85%) were 5-ALA positive. For qualitative tissue analysis, 110 of 125 samples were collected. Metastatic infiltration was present in 49 samples with faint or red fluorescence; 33 samples without fluorescence were tumor-free. The presence of metastatic infiltration correlated with fluorescence (

CONCLUSIONS: Infiltration of surrounding brain tissue is a common finding in brain metastases in selected primary tumors. 5-ALA fluorescence correlates with tumor cell infiltration and might guide more radical resection.

© 2019 The Author(s).

Keywords: 5-ALA; 5-ALA, 5-Aminolevulinic acid; Brain metastasis; Brain tumor; Fluorescence-guided surgery; Histology; NSCLC, Non–small cell lung cancer; Tumor infiltration

Conflict of interest statement

This study was funded by the German Federal Ministry of Education and Science project MetastaSys in the platform Medical Systems (0316173).

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