Skip to main content
Erschienen in: Journal of Neuro-Oncology 3/2019

10.12.2018 | Clinical Study

Is 5-ALA fluorescence of cerebral metastases a prognostic factor for local recurrence and overall survival?

verfasst von: Marcel A. Kamp, Christopher Munoz-Bendix, Hendrik-Jan Mijderwijk, Bernd Turowski, Maxine Dibué-Adjei, Christiane von Saß, Jan Frederick Cornelius, Hans-Jakob Steiger, Marion Rapp, Michael Sabel

Erschienen in: Journal of Neuro-Oncology | Ausgabe 3/2019

Einloggen, um Zugang zu erhalten

Abstract

Background

5-Aminolevulinic acid (5-ALA) fluorescence-guided resection technique was first introduced for malignant glioma. However, the impact of the 5-ALA fluorescence behaviour of cerebral metastases is still unclear. Aim of this study was to determine the impact of PpIX-fluorescence on the local progression-free and overall survival.

Materials and methods

A secondary analysis was performed and included an updated follow-up of 136 patients comprised in two previous studies. Additionally, 82 new patients were included. All patients underwent surgical resection of cerebral metastasis and intraoperative estimation of 5-ALA-induced fluorescence. The 5-ALA fluorescence behaviour of cerebral metastases was correlated with the rate of local recurrences, the local progression-free and overall survival.

Results

218 patients suffering from cerebral metastatic spread fulfilled the inclusion criteria and were analysed: complete surgical resection could be achieved in 123/218 patients (56.4%). Dichotomised degree of surgical resection (complete vs. incomplete or questionable complete resection) was not related to dichotomized 5-ALA fluorescence of cerebral metastases (p = 0.66). 51 patients (23.4%) developed a local in-brain progression within or at the border of the resection cavity. Of these, 8 patients showed a PpIX-fluorescent metastasis. There was a trend towards a correlation between a higher local in-brain progression in PpIX-non-fluorescent metastases (p = 0.03). Median time to local in-brain progression was 4 ± 11 months. PpIX-fluorescent and PpIX-non-fluorescent metastases showed a significantly different progression-free survival (p = 0.01). PpIX-positive and –negative metastases showed a significantly different overall survival (20 and 14 months respectively; p = 0.006).

Conclusion

The 5-ALA fluorescence behaviour was related to the local progression-free and the overall survival in the present retrospective series and might be considered a prognostic marker. Further studies are required to appreciate the oncological impact of the 5-ALA induced fluorescence behaviour of cerebral metastases.
Literatur
1.
Zurück zum Zitat Belloch JP, Rovira V, Llacer JL, Riesgo PA, Cremades A (2014) Fluorescence-guided surgery in high grade gliomas using an exoscope system. Acta Neurochir (Wien) 156:653–660CrossRef Belloch JP, Rovira V, Llacer JL, Riesgo PA, Cremades A (2014) Fluorescence-guided surgery in high grade gliomas using an exoscope system. Acta Neurochir (Wien) 156:653–660CrossRef
2.
Zurück zum Zitat Benveniste RJ, Ferraro N, Tsimpas A (2014) Yield and utility of routine postoperative imaging after resection of brain metastases. J Neurooncol 118:363–367CrossRefPubMed Benveniste RJ, Ferraro N, Tsimpas A (2014) Yield and utility of routine postoperative imaging after resection of brain metastases. J Neurooncol 118:363–367CrossRefPubMed
3.
Zurück zum Zitat Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, Greenspoon J, Parney IF, Laack NNI, Ashman JB, Bahary JP, Hadjipanayis CG, Urbanic JJ, Barker FG 2nd, Farace E, Khuntia D, Giannini C, Buckner JC, Galanis E, Roberge D (2017) Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC.3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 18:1049–1060CrossRefPubMedPubMedCentral Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, Greenspoon J, Parney IF, Laack NNI, Ashman JB, Bahary JP, Hadjipanayis CG, Urbanic JJ, Barker FG 2nd, Farace E, Khuntia D, Giannini C, Buckner JC, Galanis E, Roberge D (2017) Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC.3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 18:1049–1060CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Coburger J, Engelke J, Scheuerle A, Thal DR, Hlavac M, Wirtz CR, Konig R (2014) Tumor detection with 5-aminolevulinic acid fluorescence and Gd-DTPA-enhanced intraoperative MRI at the border of contrast-enhancing lesions: a prospective study based on histopathological assessment. Neurosurg Focus 36:E3CrossRefPubMed Coburger J, Engelke J, Scheuerle A, Thal DR, Hlavac M, Wirtz CR, Konig R (2014) Tumor detection with 5-aminolevulinic acid fluorescence and Gd-DTPA-enhanced intraoperative MRI at the border of contrast-enhancing lesions: a prospective study based on histopathological assessment. Neurosurg Focus 36:E3CrossRefPubMed
5.
Zurück zum Zitat Kamp MA, Dibue M, Niemann L, Reichelt DC, Felsberg J, Steiger HJ, Szelenyi A, Rapp M, Sabel M (2012) Proof of principle: supramarginal resection of cerebral metastases in eloquent brain areas. Acta Neurochir (Wien) 154:1981–1986CrossRef Kamp MA, Dibue M, Niemann L, Reichelt DC, Felsberg J, Steiger HJ, Szelenyi A, Rapp M, Sabel M (2012) Proof of principle: supramarginal resection of cerebral metastases in eloquent brain areas. Acta Neurochir (Wien) 154:1981–1986CrossRef
6.
Zurück zum Zitat Kamp MA, Dibue M, Santacroce A, Zella SM, Niemann L, Steiger HJ, Rapp M, Sabel M (2013) The tumour is not enough or is it? Problems and new concepts in the surgery of cerebral metastases. Ecancermedicalscience 7:306PubMedPubMedCentral Kamp MA, Dibue M, Santacroce A, Zella SM, Niemann L, Steiger HJ, Rapp M, Sabel M (2013) The tumour is not enough or is it? Problems and new concepts in the surgery of cerebral metastases. Ecancermedicalscience 7:306PubMedPubMedCentral
7.
Zurück zum Zitat Kamp MA, Fischer I, Buhner J, Turowski B, Cornelius JF, Steiger HJ, Rapp M, Slotty PJ, Sabel M (2016) 5-ALA fluorescence of cerebral metastases and its impact for the local-in-brain progression. Oncotarget 7:66776–66789CrossRefPubMedPubMedCentral Kamp MA, Fischer I, Buhner J, Turowski B, Cornelius JF, Steiger HJ, Rapp M, Slotty PJ, Sabel M (2016) 5-ALA fluorescence of cerebral metastases and its impact for the local-in-brain progression. Oncotarget 7:66776–66789CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Kamp MA, Fischer I, Dibue-Adjei M, Munoz-Bendix C, Cornelius JF, Steiger HJ, Slotty PJ, Turowski B, Rapp M, Sabel M (2017) Predictors for a further local in-brain progression after re-craniotomy of locally recurrent cerebral metastases. Neurosurg Rev 41:813–823CrossRefPubMed Kamp MA, Fischer I, Dibue-Adjei M, Munoz-Bendix C, Cornelius JF, Steiger HJ, Slotty PJ, Turowski B, Rapp M, Sabel M (2017) Predictors for a further local in-brain progression after re-craniotomy of locally recurrent cerebral metastases. Neurosurg Rev 41:813–823CrossRefPubMed
9.
Zurück zum Zitat Kamp MA, Grosser P, Felsberg J, Slotty PJ, Steiger HJ, Reifenberger G, Sabel M (2012) 5-Aminolevulinic acid (5-ALA)-induced fluorescence in intracerebral metastases: a retrospective study. Acta Neurochir (Wien) 154:223–228; discussion 228CrossRef Kamp MA, Grosser P, Felsberg J, Slotty PJ, Steiger HJ, Reifenberger G, Sabel M (2012) 5-Aminolevulinic acid (5-ALA)-induced fluorescence in intracerebral metastases: a retrospective study. Acta Neurochir (Wien) 154:223–228; discussion 228CrossRef
10.
Zurück zum Zitat Kamp MA, Rapp M, Buhner J, Slotty PJ, Reichelt D, Sadat H, Dibue-Adjei M, Steiger HJ, Turowski B, Sabel M (2015) Early postoperative magnet resonance tomography after resection of cerebral metastases. Acta Neurochir (Wien) 157:1573–1580CrossRef Kamp MA, Rapp M, Buhner J, Slotty PJ, Reichelt D, Sadat H, Dibue-Adjei M, Steiger HJ, Turowski B, Sabel M (2015) Early postoperative magnet resonance tomography after resection of cerebral metastases. Acta Neurochir (Wien) 157:1573–1580CrossRef
11.
Zurück zum Zitat Kamp MA, Rapp M, Slotty PJ, Turowski B, Sadat H, Smuga M, Dibue-Adjei M, Steiger HJ, Szelenyi A, Sabel M (2015) Incidence of local in-brain progression after supramarginal resection of cerebral metastases. Acta Neurochir (Wien) 157:905–910; discussion 910–901CrossRef Kamp MA, Rapp M, Slotty PJ, Turowski B, Sadat H, Smuga M, Dibue-Adjei M, Steiger HJ, Szelenyi A, Sabel M (2015) Incidence of local in-brain progression after supramarginal resection of cerebral metastases. Acta Neurochir (Wien) 157:905–910; discussion 910–901CrossRef
12.
Zurück zum Zitat Kamp MA, Slotty PJ, Cornelius JF, Steiger HJ, Rapp M, Sabel M (2016) The impact of cerebral metastases growth pattern on neurosurgical treatment. Neurosurg Rev 41:77–86CrossRefPubMed Kamp MA, Slotty PJ, Cornelius JF, Steiger HJ, Rapp M, Sabel M (2016) The impact of cerebral metastases growth pattern on neurosurgical treatment. Neurosurg Rev 41:77–86CrossRefPubMed
13.
Zurück zum Zitat Kamp MA, Cornelius JF, Steiger HJ, Sabel M (2018) 5-Aminolevulinic acid and brain metastases. In: Hadjipanayis CS, W. (ed) Fluorescence-guided neurosurgery: neuro-oncology and cerebrovascular application. Thieme, New York Kamp MA, Cornelius JF, Steiger HJ, Sabel M (2018) 5-Aminolevulinic acid and brain metastases. In: Hadjipanayis CS, W. (ed) Fluorescence-guided neurosurgery: neuro-oncology and cerebrovascular application. Thieme, New York
14.
Zurück zum Zitat Kemmner W, Wan K, Ruttinger S, Ebert B, Macdonald R, Klamm U, Moesta KT (2008) Silencing of human ferrochelatase causes abundant protoporphyrin-IX accumulation in colon cancer. FASEB J 22:500–509CrossRefPubMed Kemmner W, Wan K, Ruttinger S, Ebert B, Macdonald R, Klamm U, Moesta KT (2008) Silencing of human ferrochelatase causes abundant protoporphyrin-IX accumulation in colon cancer. FASEB J 22:500–509CrossRefPubMed
15.
Zurück zum Zitat Kocher M, Soffietti R, Abacioglu U, Villa S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Ben Hassel M, Kouri M, Valeinis E, van den Berge D, Collette S, Collette L, Mueller RP (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 29:134–141CrossRefPubMed Kocher M, Soffietti R, Abacioglu U, Villa S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Ben Hassel M, Kouri M, Valeinis E, van den Berge D, Collette S, Collette L, Mueller RP (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 29:134–141CrossRefPubMed
16.
Zurück zum Zitat Kong XTA, Bota D, D.A (2014) Epidemiology of central nervous system metastases. In: Hayat MA (ed) Brain metastases from primary tumors. epidemiology, biology, and therapy, vol 1. Academic Press, London, pp 11–23CrossRef Kong XTA, Bota D, D.A (2014) Epidemiology of central nervous system metastases. In: Hayat MA (ed) Brain metastases from primary tumors. epidemiology, biology, and therapy, vol 1. Academic Press, London, pp 11–23CrossRef
17.
Zurück zum Zitat Lin NU, Lee EQ, Aoyama H, Barani IJ, Barboriak DP, Baumert BG, Bendszus M, Brown PD, Camidge DR, Chang SM, Dancey J, de Vries EG, Gaspar LE, Harris GJ, Hodi FS, Kalkanis SN, Linskey ME, Macdonald DR, Margolin K, Mehta MP, Schiff D, Soffietti R, Suh JH, van den Bent MJ, Vogelbaum MA, Wen PY, Response Assessment in Neuro-Oncology Group (2015) Response assessment criteria for brain metastases: proposal from the RANO group. Lancet Oncol 16:e270–e278CrossRefPubMed Lin NU, Lee EQ, Aoyama H, Barani IJ, Barboriak DP, Baumert BG, Bendszus M, Brown PD, Camidge DR, Chang SM, Dancey J, de Vries EG, Gaspar LE, Harris GJ, Hodi FS, Kalkanis SN, Linskey ME, Macdonald DR, Margolin K, Mehta MP, Schiff D, Soffietti R, Suh JH, van den Bent MJ, Vogelbaum MA, Wen PY, Response Assessment in Neuro-Oncology Group (2015) Response assessment criteria for brain metastases: proposal from the RANO group. Lancet Oncol 16:e270–e278CrossRefPubMed
18.
Zurück zum Zitat Mahajan A, Ahmed S, McAleer MF, Weinberg JS, Li J, Brown P, Settle S, Prabhu SS, Lang FF, Levine N, McGovern S, Sulman E, McCutcheon IE, Azeem S, Cahill D, Tatsui C, Heimberger AB, Ferguson S, Ghia A, Demonte F, Raza S, Guha-Thakurta N, Yang J, Sawaya R, Hess KR, Rao G (2017) Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol 18:1040–1048CrossRefPubMedPubMedCentral Mahajan A, Ahmed S, McAleer MF, Weinberg JS, Li J, Brown P, Settle S, Prabhu SS, Lang FF, Levine N, McGovern S, Sulman E, McCutcheon IE, Azeem S, Cahill D, Tatsui C, Heimberger AB, Ferguson S, Ghia A, Demonte F, Raza S, Guha-Thakurta N, Yang J, Sawaya R, Hess KR, Rao G (2017) Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol 18:1040–1048CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Marbacher S, Klinger E, Schwyzer L, Fischer I, Nevzati E, Diepers M, Roelcke U, Fathi AR, Coluccia D, Fandino J (2014) Use of fluorescence to guide resection or biopsy of primary brain tumors and brain metastases. Neurosurg Focus 36:E10CrossRefPubMed Marbacher S, Klinger E, Schwyzer L, Fischer I, Nevzati E, Diepers M, Roelcke U, Fathi AR, Coluccia D, Fandino J (2014) Use of fluorescence to guide resection or biopsy of primary brain tumors and brain metastases. Neurosurg Focus 36:E10CrossRefPubMed
20.
Zurück zum Zitat Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280:1485–1489CrossRefPubMed Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280:1485–1489CrossRefPubMed
21.
Zurück zum Zitat Patel AJ, Suki D, Hatiboglu MA, Abouassi H, Shi W, Wildrick DM, Lang FF, Sawaya R (2010) Factors influencing the risk of local recurrence after resection of a single brain metastasis. J Neurosurg 113:181–189CrossRefPubMed Patel AJ, Suki D, Hatiboglu MA, Abouassi H, Shi W, Wildrick DM, Lang FF, Sawaya R (2010) Factors influencing the risk of local recurrence after resection of a single brain metastasis. J Neurosurg 113:181–189CrossRefPubMed
22.
Zurück zum Zitat Patel AJ, Suki D, Hatiboglu MA, Rao VY, Fox BD, Sawaya R (2015) Impact of surgical methodology on the complication rate and functional outcome of patients with a single brain metastasis. J Neurosurg 122:1132–1143CrossRefPubMed Patel AJ, Suki D, Hatiboglu MA, Rao VY, Fox BD, Sawaya R (2015) Impact of surgical methodology on the complication rate and functional outcome of patients with a single brain metastasis. J Neurosurg 122:1132–1143CrossRefPubMed
24.
Zurück zum Zitat Roos DE, Smith JG, Stephens SW (2011) Radiosurgery versus surgery, both with adjuvant whole brain radiotherapy, for solitary brain metastases: a randomised controlled trial. Clin Oncol (R Coll Radiol) 23:646–651CrossRef Roos DE, Smith JG, Stephens SW (2011) Radiosurgery versus surgery, both with adjuvant whole brain radiotherapy, for solitary brain metastases: a randomised controlled trial. Clin Oncol (R Coll Radiol) 23:646–651CrossRef
25.
Zurück zum Zitat Sabel M, Knipps J, Neumann LM, Kieslich M, Steiger HJ, Rapp M, Kamp MA (2018) Quantification of ALA-fluorescence induced by a modified commercially available head lamp and a surgical microscope. Neurosurg Rev 41:1079–1083CrossRefPubMed Sabel M, Knipps J, Neumann LM, Kieslich M, Steiger HJ, Rapp M, Kamp MA (2018) Quantification of ALA-fluorescence induced by a modified commercially available head lamp and a surgical microscope. Neurosurg Rev 41:1079–1083CrossRefPubMed
26.
Zurück zum Zitat Salas S, Brulard C, Terrier P, Ranchere-Vince D, Neuville A, Guillou L, Lae M, Leroux A, Verola O, Jean-Emmanuel K, Bonvalot S, Blay JY, Le Cesne A, Aurias A, Coindre JM, Chibon F (2015) Gene expression profiling of desmoid tumors by cDNA microarrays and correlation with progression-free survival. Clin Cancer Res 21:4194–4200CrossRefPubMed Salas S, Brulard C, Terrier P, Ranchere-Vince D, Neuville A, Guillou L, Lae M, Leroux A, Verola O, Jean-Emmanuel K, Bonvalot S, Blay JY, Le Cesne A, Aurias A, Coindre JM, Chibon F (2015) Gene expression profiling of desmoid tumors by cDNA microarrays and correlation with progression-free survival. Clin Cancer Res 21:4194–4200CrossRefPubMed
27.
Zurück zum Zitat Sawaya R (2001) Considerations in the diagnosis and management of brain metastases. Oncology 15:1144–1154, 1157 – 1148; discussion 1158, 1163 – 1145PubMed Sawaya R (2001) Considerations in the diagnosis and management of brain metastases. Oncology 15:1144–1154, 1157 – 1148; discussion 1158, 1163 – 1145PubMed
28.
Zurück zum Zitat Schucht P, Beck J, Vajtai I, Raabe A (2011) Paradoxical fluorescence after administration of 5-aminolevulinic acid for resection of a cerebral melanoma metastasis. Acta Neurochir 153:1497–1499CrossRefPubMed Schucht P, Beck J, Vajtai I, Raabe A (2011) Paradoxical fluorescence after administration of 5-aminolevulinic acid for resection of a cerebral melanoma metastasis. Acta Neurochir 153:1497–1499CrossRefPubMed
29.
Zurück zum Zitat Stummer W, Kamp MA (2009) The importance of surgical resection in malignant glioma. Curr Opin Neurol 22:645–649CrossRefPubMed Stummer W, Kamp MA (2009) The importance of surgical resection in malignant glioma. Curr Opin Neurol 22:645–649CrossRefPubMed
30.
Zurück zum Zitat Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ, Group AL-GS (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7:392–401CrossRefPubMed Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ, Group AL-GS (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7:392–401CrossRefPubMed
31.
Zurück zum Zitat Stummer W, Stocker S, Novotny A, Heimann A, Sauer O, Kempski O, Plesnila N, Wietzorrek J, Reulen HJ (1998) In vitro and in vivo porphyrin accumulation by C6 glioma cells after exposure to 5-aminolevulinic acid. J Photochem Photobiol B 45:160–169CrossRefPubMed Stummer W, Stocker S, Novotny A, Heimann A, Sauer O, Kempski O, Plesnila N, Wietzorrek J, Reulen HJ (1998) In vitro and in vivo porphyrin accumulation by C6 glioma cells after exposure to 5-aminolevulinic acid. J Photochem Photobiol B 45:160–169CrossRefPubMed
32.
Zurück zum Zitat Suki D, Abouassi H, Patel AJ, Sawaya R, Weinberg JS, Groves MD (2008) Comparative risk of leptomeningeal disease after resection or stereotactic radiosurgery for solid tumor metastasis to the posterior fossa. J Neurosurg 108:248–257CrossRefPubMed Suki D, Abouassi H, Patel AJ, Sawaya R, Weinberg JS, Groves MD (2008) Comparative risk of leptomeningeal disease after resection or stereotactic radiosurgery for solid tumor metastasis to the posterior fossa. J Neurosurg 108:248–257CrossRefPubMed
33.
Zurück zum Zitat Utsuki S, Miyoshi N, Oka H, Miyajima Y, Shimizu S, Suzuki S, Fujii K (2007) Fluorescence-guided resection of metastatic brain tumors using a 5-aminolevulinic acid-induced protoporphyrin IX: pathological study. Brain Tumor Pathol 24:53–55CrossRefPubMed Utsuki S, Miyoshi N, Oka H, Miyajima Y, Shimizu S, Suzuki S, Fujii K (2007) Fluorescence-guided resection of metastatic brain tumors using a 5-aminolevulinic acid-induced protoporphyrin IX: pathological study. Brain Tumor Pathol 24:53–55CrossRefPubMed
34.
Zurück zum Zitat Valdes PA, Leblond F, Kim A, Harris BT, Wilson BC, Fan X, Tosteson TD, Hartov A, Ji S, Erkmen K, Simmons NE, Paulsen KD, Roberts DW (2011) Quantitative fluorescence in intracranial tumor: implications for ALA-induced PpIX as an intraoperative biomarker. J Neurosurg 115:11–17CrossRefPubMedPubMedCentral Valdes PA, Leblond F, Kim A, Harris BT, Wilson BC, Fan X, Tosteson TD, Hartov A, Ji S, Erkmen K, Simmons NE, Paulsen KD, Roberts DW (2011) Quantitative fluorescence in intracranial tumor: implications for ALA-induced PpIX as an intraoperative biomarker. J Neurosurg 115:11–17CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Widhalm G, Minchev G, Woehrer A, Preusser M, Kiesel B, Furtner J, Mert A, Di Ieva A, Tomanek B, Prayer D, Marosi C, Hainfellner JA, Knosp E, Wolfsberger S (2012) Strong 5-aminolevulinic acid-induced fluorescence is a novel intraoperative marker for representative tissue samples in stereotactic brain tumor biopsies. Neurosurg Rev 35:381–391; discussion 391CrossRefPubMed Widhalm G, Minchev G, Woehrer A, Preusser M, Kiesel B, Furtner J, Mert A, Di Ieva A, Tomanek B, Prayer D, Marosi C, Hainfellner JA, Knosp E, Wolfsberger S (2012) Strong 5-aminolevulinic acid-induced fluorescence is a novel intraoperative marker for representative tissue samples in stereotactic brain tumor biopsies. Neurosurg Rev 35:381–391; discussion 391CrossRefPubMed
36.
Zurück zum Zitat Yoo H, Kim YZ, Nam BH, Shin SH, Yang HS, Lee JS, Zo JI, Lee SH (2009) Reduced local recurrence of a single brain metastasis through microscopic total resection. J Neurosurg 110:730–736CrossRefPubMed Yoo H, Kim YZ, Nam BH, Shin SH, Yang HS, Lee JS, Zo JI, Lee SH (2009) Reduced local recurrence of a single brain metastasis through microscopic total resection. J Neurosurg 110:730–736CrossRefPubMed
Metadaten
Titel
Is 5-ALA fluorescence of cerebral metastases a prognostic factor for local recurrence and overall survival?
verfasst von
Marcel A. Kamp
Christopher Munoz-Bendix
Hendrik-Jan Mijderwijk
Bernd Turowski
Maxine Dibué-Adjei
Christiane von Saß
Jan Frederick Cornelius
Hans-Jakob Steiger
Marion Rapp
Michael Sabel
Publikationsdatum
10.12.2018
Verlag
Springer US
Erschienen in
Journal of Neuro-Oncology / Ausgabe 3/2019
Print ISSN: 0167-594X
Elektronische ISSN: 1573-7373
DOI
https://doi.org/10.1007/s11060-018-03066-y

Weitere Artikel der Ausgabe 3/2019

Journal of Neuro-Oncology 3/2019 Zur Ausgabe

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Neu im Fachgebiet Neurologie

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.