Hypericin for visualization of high grade gliomas: First clinical experience

Ritz, Rainer; Daniels, Rolf; Noell, Susan; Feigl, Guenther C.; Schmidt, Volker; Bornemann, Antje; Ramina, Kristofer; Mayer, Daniel; Dietz, Klaus; Strauß, Wolfgang S. L.; Tatagiba, Marcos

doi:10.1016/j.ejso.2011.12.021

Cited by 39 publications

(20 citation statements)

References 23 publications

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“…Sixty-four studies describe the clinical use of fluorescent agents [1, 3, 5, 6, 9, 11, 13–16, 22–26, 28–31, 33–35, 37, 38, 40–42, 44, 49, 52–54, 58, 64–66, 69, 71, 74, 75, 78, 80–82, 84–87, 89, 92, 94, 97–101, 105–107, 109, 110, 113, 115, 118]. Three ways of labeling tumor cells were identified in the literature: (1) passive, (2) metabolic, and (3) molecular labeling.…”

Section: Resultsmentioning

confidence: 99%

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Agents for fluorescence-guided glioma surgery: a systematic review of preclinical and clinical results

et al. 2016

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BackgroundFluorescence-guided surgery (FGS) is a technique used to enhance visualization of tumor margins in order to increase the extent of tumor resection in glioma surgery. In this paper, we systematically review all clinically tested fluorescent agents for application in FGS for glioma and all preclinically tested agents with the potential for FGS for glioma.MethodsWe searched the PubMed and Embase databases for all potentially relevant studies through March 2016. We assessed fluorescent agents by the following outcomes: rate of gross total resection (GTR), overall and progression-free survival, sensitivity and specificity in discriminating tumor and healthy brain tissue, tumor-to-normal ratio of fluorescent signal, and incidence of adverse events.ResultsThe search strategy resulted in 2155 articles that were screened by titles and abstracts. After full-text screening, 105 articles fulfilled the inclusion criteria evaluating the following fluorescent agents: 5-aminolevulinic acid (5-ALA) (44 studies, including three randomized control trials), fluorescein (11), indocyanine green (five), hypericin (two), 5-aminofluorescein-human serum albumin (one), endogenous fluorophores (nine) and fluorescent agents in a pre-clinical testing phase (30). Three meta-analyses were also identified.Conclusions5-ALA is the only fluorescent agent that has been tested in a randomized controlled trial and results in an improvement of GTR and progression-free survival in high-grade gliomas. Observational cohort studies and case series suggest similar outcomes for FGS using fluorescein. Molecular targeting agents (e.g., fluorophore/nanoparticle labeled with anti-EGFR antibodies) are still in the pre-clinical phase, but offer promising results and may be valuable future alternatives.

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Section: Resultsmentioning

confidence: 99%

“…Tissue samples from fluorescent and non-fluorescent areas showed a sensitivity and specificity in distinguishing human brain and tumor tissue of 91–94% and 90–100%, respectively. No side effects were observed [80]. In an animal study, rats were implanted with GBM cells and intravenously injected with hypericin.…”

Section: Resultsmentioning

confidence: 99%

Agents for fluorescence-guided glioma surgery: a systematic review of preclinical and clinical results

et al. 2016

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“…Over the past six decades, a variety of innovative techniques have been developed by neurosurgeons to increase the efficacy of resecting primary malignant brain tumors such as intraoperative ultrasound, neuronavigation, intraoperative MRI, cortical stimulations and fluorescence-guided resection 11, 12. Among these methods, fluorescence-guided resection has shown great promise because it allows intraoperative visualization of tumor boundaries, which are otherwise difficult to recognize 1, 5, 6, 13-17.…”

Section: Discussionmentioning

confidence: 99%

Gross Total Resection of Glioma with the Intraoperative Fluorescence-guidance of Fluorescein Sodium

Chen¹,

Wang²,

Ge³

et al. 2012

Int. J. Med. Sci.

110

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Objective. High dose fluorescein sodium has been utilized for fluorescence-guided tumor resection with conflicting reports on the efficacy of this procedure. The aim of this study was to reevaluate the utility and clinical limitations of using fluorescein sodium for the treatment and resection of glioma brain tumors.Methods. Patients diagnosed with glioma were divided into two groups with a total of 22 patients enrolled in the study: 1) the study group (n=10), patients that received intravenous injection of fluorescein sodium and 2) the control group (n=12), patients that did not receive injections during surgical resection. Quality of life was evaluated according to Karnofsky Performance Scale (KPS) score and neurological status. Fluorescein sodium was intravenously injected at a dose of 15-20mg/kg of body weight. Glioma resection was evaluated preoperative and postoperatively with enhanced Magnetic Resonance Imaging (MRI).Results. Significant differences in the gross total resection (GTR) rates were observed between the two patient groups (Fisher's Exact Test p=0.047). Progressive free survival was significantly longer in the study group (Student's T-Test p=0.033) as well as in the GTR group (Student's T-Test p=0.0001) compared to the control and non-GTR groups, respectively. Three patients in the study group and four patients in the control group had transient neurological deterioration. One patient in the control group had permanent hemiplegia.Conclusion. The intraoperative utility of using fluorescein sodium can significantly increase the GTR rate without obvious deterioration. In addition, we find that it is better to apply the fluorescein sodium in the cases with BBB (blood-brain barrier) disruption, which had been enhanced in preoperative MRI.

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“…An endoscopic procedure for which 5-ALA is administered is well established as a diagnostic tool for cancers such as bladder, oral, laryngeal, esophageal, bronchial tract, and peritoneal cancer [42][43][44][45].…”

Section: Neuroendoscopy With 5-alamentioning

confidence: 99%

Review of Neurosurgical Fluorescence Imaging Systems for Clinical Application

Kim

Lee

Yoo

et al. 2016

Journal of the Optical Society of Korea

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A number of fluorescence imaging techniques for use in the surgical removal of glioma have been developed over the course of the long history of neurosurgery. Various biomarkers, biochemical agents, and detection systems for glioma have also been developed. This review focuses on 5-aminolevulinic acid (5-ALA), which is used to detect glioma. Numerous forms of fluorescence-guided surgery use 5-ALA, which is helpful to the surgeon. The surgical microscope system is the observational method generally used with 5-ALA, while the loupe, endoscope, and exoscope are simpler alternatives. A system is needed for minimal resection and other issues that arise during neurosurgery. Such an enhanced system should be able to detect low-grade tumors and provide information on microinvasive diseases, resulting in an improved survival rate and better surgical skills. Development of systems that fulfill certain needs would help protect the brain function of the patient and broaden the use of such systems in neurosurgery.

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Hypericin for visualization of high grade gliomas: First clinical experience

Cited by 39 publications

References 23 publications

Agents for fluorescence-guided glioma surgery: a systematic review of preclinical and clinical results

Agents for fluorescence-guided glioma surgery: a systematic review of preclinical and clinical results

Gross Total Resection of Glioma with the Intraoperative Fluorescence-guidance of Fluorescein Sodium

Review of Neurosurgical Fluorescence Imaging Systems for Clinical Application

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