Technique that makes brain tumours fluoresce improves surgical outcome

A new technique that causes brain tumours to fluoresce results in more complete removal of the tumour and in improved progression-free survival, report German researchers in the May issue of The Lancet Oncology. "This technique is an advance over older, traditional methods, because it is simple, cheap, can be performed in real-time, and has now been put to a truly prospective test", claims coordinating investigator Dr Walter Stummer.

The brain tumours, known as malignant gliomas, have a poor prognosis despite the range of treatments currently available, and investigators have suggested that the poor results during surgery could be because it is difficult to see where the tumour stops and healthy tissue starts, making complete removal difficult. "Traditional techniques used for improving resections have not fulfilled expectations (frameless stereotaxy) or are still too expensive and cumbersome (intraoperative MRI) to have been put to broad scale use", notes Dr Stummer.

Researchers from the ALA-Glioma Study Group therefore investigated a new way to detect the tumours during surgery, by using a drug called 5-aminolevulinic acid, which causes fluorescent compounds to accumulate in cancerous tissue. "The tumours can then be visualised with a modified microscope during neurosurgery in a simple, economical, real-time procedure", adds Dr Stummer.

The investigators compared two groups of patients, one of which was operated on with fluorescence-guided surgery and the other who received the usual surgical procedure under white light. They found that after a median follow-up of 354 months, not only was the number of patients who had their tumours removed completely higher in the group that received fluorescence-guided surgery than in those who received usual surgery (65% vs 36%), but also, more people in this group survived to 6 months without progression of their tumour (41% vs 21%). Furthermore, there was no difference in serious side-effects between the groups.

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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