Rasmus W Hansen1,2, Christian B Pedersen1, Bo Halle1, Anders R Korshoej1,3, Mette K Schulz1, Bjarne W Kristensen4, Frantz R Poulsen1,2. 1. 1Department of Neurosurgery, Odense University Hospital, Clinical Institute, University of Southern Denmark and BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Odense. 2. 4Odense Patient Data Explorative Network, Odense, Denmark. 3. 2Department of Neurosurgery, Aarhus University Hospital, Aarhus. 4. 3Department of Pathology, Odense University Hospital; and.
Abstract
OBJECTIVE: Maximal safe resection is an important surgical goal in the treatment for high-grade gliomas. Fluorescent dyes help the surgeon to distinguish malignant tissue from healthy. The aims of this study were 1) to compare the 2 fluorescent dyes 5-aminolevulinic acid (5-ALA) and sodium fluorescein (fluorescein) regarding extent of resection, progression-free survival, and overall survival; and 2) to assess the influence of other risk factors on clinical outcome and screen for potential disadvantages of the dyes. METHODS: A total of 209 patients with high-grade gliomas were included in this retrospective study. Resections were performed in the period from 2012 to 2017 using 5-ALA or fluorescein. Extent of resection was assessed as the difference in tumor volume between early postoperative and preoperative MRI studies. Tumor progression-free survival and overall survival were analyzed using an adjusted Cox proportional hazards model. RESULTS: One hundred fifty-eight patients were operated on with 5-ALA and 51 with fluorescein. The median duration of follow-up was 46.7 and 21.2 months, respectively. Covariables were evenly distributed. There was no statistically significant difference in volumetrically assessed median extent of resection (96.9% for 5-ALA vs 97.4% for fluorescein, p = 0.46) or the percentage of patients with residual tumor volume less than 0.175 cm3 (29.5% for 5-ALA vs 36.2% for fluorescein, p = 0.39). The median overall survival was 14.8 months for the 5-ALA group and 19.7 months for the fluorescein group (p = 0.06). The median adjusted progression-free survival was 8.7 months for the 5-ALA group and 9.2 months for the fluorescein group (p = 0.03). CONCLUSIONS: Fluorescein can be used as a viable alternative to 5-ALA for intraoperative fluorescent guidance in brain tumor surgery. Comparative, prospective, and randomized studies are much needed.
OBJECTIVE: Maximal safe resection is an important surgical goal in the treatment for high-grade gliomas. Fluorescent dyes help the surgeon to distinguish malignant tissue from healthy. The aims of this study were 1) to compare the 2 fluorescent dyes 5-aminolevulinic acid (5-ALA) and sodium fluorescein (fluorescein) regarding extent of resection, progression-free survival, and overall survival; and 2) to assess the influence of other risk factors on clinical outcome and screen for potential disadvantages of the dyes. METHODS: A total of 209 patients with high-grade gliomas were included in this retrospective study. Resections were performed in the period from 2012 to 2017 using 5-ALA or fluorescein. Extent of resection was assessed as the difference in tumor volume between early postoperative and preoperative MRI studies. Tumor progression-free survival and overall survival were analyzed using an adjusted Cox proportional hazards model. RESULTS: One hundred fifty-eight patients were operated on with 5-ALA and 51 with fluorescein. The median duration of follow-up was 46.7 and 21.2 months, respectively. Covariables were evenly distributed. There was no statistically significant difference in volumetrically assessed median extent of resection (96.9% for 5-ALA vs 97.4% for fluorescein, p = 0.46) or the percentage of patients with residual tumor volume less than 0.175 cm3 (29.5% for 5-ALA vs 36.2% for fluorescein, p = 0.39). The median overall survival was 14.8 months for the 5-ALA group and 19.7 months for the fluorescein group (p = 0.06). The median adjusted progression-free survival was 8.7 months for the 5-ALA group and 9.2 months for the fluorescein group (p = 0.03). CONCLUSIONS:Fluorescein can be used as a viable alternative to 5-ALA for intraoperative fluorescent guidance in brain tumor surgery. Comparative, prospective, and randomized studies are much needed.
Authors: Pietro Zeppa; Raffaele De Marco; Matteo Monticelli; Armando Massara; Andrea Bianconi; Giuseppe Di Perna; Stefania Greco Crasto; Fabio Cofano; Antonio Melcarne; Michele Maria Lanotte; Diego Garbossa Journal: Brain Sci Date: 2022-04-26
Authors: Lasse Cramer Ahrens; Mathias Green Krabbenhøft; Rasmus Würgler Hansen; Nikola Mikic; Christian Bonde Pedersen; Frantz Rom Poulsen; Anders Rosendal Korshoej Journal: Cancers (Basel) Date: 2022-01-26 Impact factor: 6.639
Authors: Jasper Kees Wim Gerritsen; Marike Lianne Daphne Broekman; Steven De Vleeschouwer; Philippe Schucht; Brian Vala Nahed; Mitchel Stuart Berger; Arnaud Jean Pierre Edouard Vincent Journal: Neurooncol Pract Date: 2022-03-02