Simultaneous fluorescein sodium and 5-ALA in fluorescence-guided glioma surgery

Schwake, Michael; Stummer, Walter; Molina, Eric Suero; Wölfer, Johannes

doi:10.1007/s00701-015-2401-0

Cited by 60 publications

(47 citation statements)

References 5 publications

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“…Thus, its accumulation in tumor tissue is not related to a specific uptake by tumor cells. This nonspecific mechanism of action could theoretically lead to a reduced accuracy in terms of tumor identification, as hypothesized by some authors (47). Nevertheless, we performed 50 biopsies (26 in fluorescent tissue and 24 in nonfluorescent tissue) at the tumor margin in 13 patients, obtaining a sensitivity and specificity in tumor identification of respectively 80.8% and 79.1%, and a PPV and NPV of, respectively, 80.8% and 79.1%.…”

Section: Discussionmentioning

confidence: 90%

“…This allows accumulation of the molecule into the tumor mass and a good discrimination with brain parenchyma. The acute SF injection (in bolus or immediately before dural opening), used by some authors (47), is always associated with an intense fluorescence in the normal brain tissue due to perfusion of small capillary vessels, making any discrimination between tumoral and peritumoral tissue very difficult (49). The accuracy in tumor tissue identification is further strengthened by the absence of statistically significant deterioration in NIHSS and KPS for lesions located in non-eloquent areas and by the slight decline in the same scales observed in the immediate postoperative period for grade II-III lesions, that returned to baseline level at 3 months post-op, similarly to what can be observed in other series of patients with tumors in eloquent areas, without the use of fluorescein-guided technique (26,50).…”

Section: Discussionmentioning

confidence: 99%

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Fluorescein-Guided Surgery for Resection of High-Grade Gliomas: A Multicentric Prospective Phase II Study (FLUOGLIO)

Acerbi

Broggi

Schebesch

et al. 2018

Clinical Cancer Research

165

145

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Purpose: Sodium fluorescein is a dye that, intravenously injected, selectively accumulates in high-grade glioma (HGG) tissue through a damaged blood-brain barrier. In this article, the final results of a multicentric prospective phase II trial (FLUO-GLIO) on fluorescein-guided HGG resection through a dedicated filter on the surgical microscope were reported.Methods: Patients with suspected HGGs considered suitable for removal were eligible to participate in this trial. Fluorescein was intravenously injected at a dose of 5 to 10 mg/kg. The primary endpoint was the percentage of patients with histologically confirmed HGGs, without contrast-enhancing tumor at the immediate postoperative MRI. Secondary endpoints were PFS, residual tumor on postoperative MRI, overall survival, neurologic deficits, and fluorescein-related toxicity. The sensitivity and specificity of fluorescein in identifying tumor tissue were estimated by fluorescent and nonfluorescent biopsies at the tumor margin. The study was registered on the European Regulatory Authorities website (EudraCT 2011-002527-18).Results: Fifty-seven patients aged 45 to 75 years were screened for participation, and 46 were considered for primary and secondary endpoints. Mean preoperative tumor volume was 28.75 cm 3 (range, 1.3-87.8 cm 3 ). Thirty-eight patients (82.6%) underwent a complete tumor removal. Median follow-up was 11 months. PFS-6 and PFS-12 were 56.6% and 15.2%. Median survival was 12 months. No adverse reaction related to SF administration was recorded. The sensitivity and specificity of fluorescein in identifying tumor tissue were respectively 80.8% and 79.1%.Conclusions: Fluorescein-guided technique with a dedicated filter on the surgical microscope is safe and enables a high percentage of contrast-enhancing tumor in patients with HGGs.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Fluorescein-Guided Surgery for Resection of High-Grade Gliomas: A Multicentric Prospective Phase II Study (FLUOGLIO)

Acerbi

Broggi

Schebesch

et al. 2018

Clinical Cancer Research

165

145

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“…We read with great interest and surprise the article entitled BSimultaneous fluorescein sodium and 5-ALA in fluorescence-guided glioma surgery^by Schwake et al [5], recently published in Acta Neurochirurgica.…”

Section: Dear Editormentioning

confidence: 96%

“…In their paper, Schwake et al [5] state that little is known about the best timing of i.v. fluorescein administration before tumour resection; this is only partially true.…”

Section: Dear Editormentioning

confidence: 98%

“…

Dear Editor,We read with great interest and surprise the article entitled BSimultaneous fluorescein sodium and 5-ALA in fluorescence-guided glioma surgery^by Schwake et al [5], recently published in Acta Neurochirurgica.Fluorescein-guided technique has been used since 1948 to better visualise tumour tissue due to fluorescein capability to accumulate in areas of blood-brain barrier disruption, as it happens for high-grade gliomas (HGG) [4]. Recently, there has been a renewed interest in fluorescein-guided removal of HGG for the possibility to use a dedicated filter on the surgical microscope (Pentero with Yellow 560 module; Karl Zeiss, Oberkochen, Germany) that is specific for the excitation and emission wavelength of fluorescein and allows a visualisation of non-fluorescent tissue in more natural colour [2].

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mentioning

confidence: 97%

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What is the best timing for fluorescein injection during surgical removal of high-grade gliomas?

Acerbi

Broggi

et al. 2015

Acta Neurochir

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Dear Editor,We read with great interest and surprise the article entitled BSimultaneous fluorescein sodium and 5-ALA in fluorescence-guided glioma surgery^by Schwake et al. [5], recently published in Acta Neurochirurgica.Fluorescein-guided technique has been used since 1948 to better visualise tumour tissue due to fluorescein capability to accumulate in areas of blood-brain barrier disruption, as it happens for high-grade gliomas (HGG) [4]. Recently, there has been a renewed interest in fluorescein-guided removal of HGG for the possibility to use a dedicated filter on the surgical microscope (Pentero with Yellow 560 module; Karl Zeiss, Oberkochen, Germany) that is specific for the excitation and emission wavelength of fluorescein and allows a visualisation of non-fluorescent tissue in more natural colour [2]. Based on this new possibility, and due to the low cost and ease of use of fluorescein, we have specifically designed a phase-II trial, nam ely FLUOGLIO, to assess safety and obtain first information about efficacy of fluorescein-guided technique for HGG removal. To our knowledge, this is the only ongoing clinical trial on the use of fluorescein for HGG resection. Preliminary results of this trial showed no adverse event due to fluorescein administration, an 80 % of complete resection of the contrast-enhanced tumour at early post-operative magnetic resonance imaging (MRI) and, with a median duration of follow-up of 10 months, a 6-month progression-free survival (PFS) of 71.4 % and a median survival of 11 months [1]. Furthermore, biopsies at the tumour margins (in fluorescent and non-fluorescent areas) allowed the estimation of a sensitivity of 94 % and a specificity of 89.5 % of fluorescein in identifying tumour tissue [1]. We have almost completed the enrolment phase of this study and we will be able to have data about long-term results in Fig.

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Real‐Time Imaging of Brain Tumor for Image‐Guided Surgery

Kang

Baek

et al. 2018

Adv Healthcare Materials

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The completion of surgical resection is a key prognostic factor in brain tumor treatment. This requires surgeons to identify residual tumors in theater as well as to margin the proximity of the tumor to adjacent normal tissue. Subjective assessments, such as texture palpation or visual tissue differences, are commonly used by oncology surgeons during resection to differentiate cancer lesions from normal tissue, which can potentially result in either an incomplete tumor resection, or accidental removal of normal tissue. Moreover, malignant brain tumors are even more difficult to distinguish from normal brain tissue, and resecting noncancerous tissue may create neurological defects after surgery. To optimize the resection margin in brain tumors, a variety of intraoperative guidance techniques are developed, such as neuronavigation, magnetic resonance imaging, ultrasound, Raman spectroscopy, and optical fluorescence imaging. When combined with appropriate contrast agents, optical fluorescence imaging can provide the neurosurgeon real-time image guidance to improve resection completeness and to decrease surgical complications.

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Simultaneous fluorescein sodium and 5-ALA in fluorescence-guided glioma surgery

Cited by 60 publications

References 5 publications

Fluorescein-Guided Surgery for Resection of High-Grade Gliomas: A Multicentric Prospective Phase II Study (FLUOGLIO)

Fluorescein-Guided Surgery for Resection of High-Grade Gliomas: A Multicentric Prospective Phase II Study (FLUOGLIO)

What is the best timing for fluorescein injection during surgical removal of high-grade gliomas?

Real‐Time Imaging of Brain Tumor for Image‐Guided Surgery

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