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da Silva EB, Vasquez MWM, de Almeida Teixeira BC, Neto MC, Sprenger F, Filho JLN, Almeida-Lopes L, Ramina R. Association of 5-aminolevulinic acid fluorescence guided resection with photodynamic therapy in recurrent glioblastoma: a matched cohort study. Acta Neurochir (Wien) 2024; 166:212. [PMID: 38739282 DOI: 10.1007/s00701-024-06108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Glioblastoma is a malignant and aggressive brain tumour that, although there have been improvements in the first line treatment, there is still no consensus regarding the best standard of care (SOC) upon its inevitable recurrence. There are novel adjuvant therapies that aim to improve local disease control. Nowadays, the association of intraoperative photodynamic therapy (PDT) immediately after a 5-aminolevulinic acid (5-ALA) fluorescence-guided resection (FGR) in malignant gliomas surgery has emerged as a potential and feasible strategy to increase the extent of safe resection and destroy residual tumour in the surgical cavity borders, respectively. OBJECTIVES To assess the survival rates and safety of the association of intraoperative PDT with 5-ALA FGR, in comparison with a 5-ALA FGR alone, in patients with recurrent glioblastoma. METHODS This article describes a matched-pair cohort study with two groups of patients submitted to 5-ALA FGR for recurrent glioblastoma. Group 1 was a prospective series of 11 consecutive cases submitted to 5-ALA FGR plus intraoperative PDT; group 2 was a historical series of 11 consecutive cases submitted to 5-ALA FGR alone. Age, sex, Karnofsky performance scale (KPS), 5-ALA post-resection status, T1-contrast-enhanced extent of resection (EOR), previous and post pathology, IDH (Isocitrate dehydrogenase), Ki67, previous and post treatment, brain magnetic resonance imaging (MRI) controls and surgical complications were documented. RESULTS The Mantel-Cox test showed a significant difference between the survival rates (p = 0.008) of both groups. 4 postoperative complications occurred (36.6%) in each group. As of the last follow-up (January 2024), 7/11 patients in group 1, and 0/11 patients in group 2 were still alive. 6- and 12-months post-treatment, a survival proportion of 71,59% and 57,27% is expected in group 1, versus 45,45% and 9,09% in group 2, respectively. 6 months post-treatment, a progression free survival (PFS) of 61,36% and 18,18% is expected in group 1 and group 2, respectively. CONCLUSION The association of PDT immediately after 5-ALA FGR for recurrent malignant glioma seems to be associated with better survival without additional or severe morbidity. Despite the need for larger, randomized series, the proposed treatment is a feasible and safe addition to the reoperation.
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Affiliation(s)
- Erasmo Barros da Silva
- Division of Neurooncology, Department of Neurosurgery, Instituto de Neurologia de Curitiba, Rua Jeremias Maciel Perretto, 300 - Campo Comprido, Curitiba, PR, 81210-310, Brazil.
- Instituto de Oncologia Do Paraná, Curitiba, PR, Brazil.
| | | | | | - Maurício Coelho Neto
- Division of Neurooncology, Department of Neurosurgery, Instituto de Neurologia de Curitiba, Rua Jeremias Maciel Perretto, 300 - Campo Comprido, Curitiba, PR, 81210-310, Brazil
| | - Flávia Sprenger
- Department of Neuroradiology, Instituto de Neurologia de Curitiba, Curitiba, PR, Brazil
| | - Jorge Luis Novak Filho
- Division of Neurooncology, Department of Neurosurgery, Instituto de Neurologia de Curitiba, Rua Jeremias Maciel Perretto, 300 - Campo Comprido, Curitiba, PR, 81210-310, Brazil
| | - Luciana Almeida-Lopes
- DMC Equipamentos LTDA, São Carlos, SP, Brazil
- Nupen Institute, São Carlos, SP, Brazil
| | - Ricardo Ramina
- Division of Neurooncology, Department of Neurosurgery, Instituto de Neurologia de Curitiba, Rua Jeremias Maciel Perretto, 300 - Campo Comprido, Curitiba, PR, 81210-310, Brazil
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Shetty K, Yadav KS. Temozolomide nano-in-nanofiber delivery system with sustained release and enhanced cellular uptake by U87MG cells. Drug Dev Ind Pharm 2024; 50:420-431. [PMID: 38502031 DOI: 10.1080/03639045.2024.2332906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 03/15/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE The study was aimed at formulating temozolomide (TMZ) loaded gelatin nanoparticles (GNPs) encapsulated into polyvinyl alcohol (PVA) nanofibers (TMZ-GNPs-PVA NFs) as the nano-in-nanofiber delivery system. The secondary objective was to explore the sustained releasing ability of this system and to assess its enhanced cellular uptake against U87MG glioma cells in vitro. SIGNIFICANCE Nano-in-nanofibers are the emerging drug delivery systems for treating a wide range of diseases including cancers as they overcome the challenges experienced by nanoparticles and nanofibers alone. METHODS The drug-loaded GNPs were formulated by one-step desolvation method. The Design of Experiments (DoE) was used to optimize nanoparticle size and entrapment efficiency. The optimized drug-loaded nanoparticles were then encapsulated within nanofibers using blend electrospinning technique. The U87MG glioma cells were used to investigate the uptake of the formulation. RESULTS A 32 factorial design was used to optimize the mean particle size (145.7 nm) and entrapment efficiency (87.6%) of the TMZ-loaded GNPs which were subsequently ingrained into PVA nanofibers by electrospinning technique. The delivery system achieved a sustained drug release for up to seven days (in vitro). The SEM results ensured that the expected nano-in-nanofiber delivery system was achieved. The uptake of TMZ-GNPs-PVA NFs by cells was increased by a factor of 1.964 compared to that of the pure drug. CONCLUSION The nano-in-nanofiber drug delivery system is a potentially useful therapeutic strategy for the management of glioblastoma multiforme.
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Affiliation(s)
- Karishma Shetty
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM'S NMIMS (Deemed to be University), Mumbai, India
| | - Khushwant S Yadav
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM'S NMIMS (Deemed to be University), Mumbai, India
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3
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Liu X, Wu L, Wang L, Li Y. Identification and classification of glioma subtypes based on RNA-binding proteins. Comput Biol Med 2024; 174:108404. [PMID: 38582000 DOI: 10.1016/j.compbiomed.2024.108404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/23/2024] [Accepted: 04/01/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Glioma is a common and aggressive primary malignant cancer known for its high morbidity, mortality, and recurrence rates. Despite this, treatment options for glioma are currently restricted. The dysregulation of RBPs has been linked to the advancement of several types of cancer, but their precise role in glioma evolution is still not fully understood. This study sought to investigate how RBPs may impact the development and prognosis of glioma, with potential implications for prognosis and therapy. METHODS RNA-seq profiles of glioma and corresponding clinical data from the CGGA database were initially collected for analysis. Unsupervised clustering was utilized to identify crucial tumor subtypes in glioma development. Subsequent time-series analysis and MS model were employed to track the progression of these identified subtypes. RBPs playing a significant role in glioma progression were then pinpointed using WGCNA and Lasso Cox regression models. Functional analysis of these key RBP-related genes was conducted through GSEA. Additionally, the CIBERSORT algorithm was utilized to estimate immune infiltrating cells, while the STRING database was consulted to uncover potential mechanisms of the identified biomarkers. RESULTS Six tumor subgroups were identified and found to be highly homogeneous within each subgroup. The progression stages of these tumor subgroups were determined using time-series analysis and a MS model. Through WGCNA, Lasso Cox, and multivariate Cox regression analysis, it was confirmed that BCLAF1 is correlated with survival in glioma patients and is closely linked to glioma progression. Functional annotation suggests that BCLAF1 may impact glioma progression by influencing RNA splicing, which in turn affects the cell cycle, Wnt signaling pathway, and other cancer development pathways. CONCLUSIONS The study initially identified six subtypes of glioma progression and assessed their malignancy ranking. Furthermore, it was determined that BCLAF1 could serve as an RBP-related prognostic marker, offering significant implications for the clinical diagnosis and personalized treatment of glioma.
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Affiliation(s)
- Xudong Liu
- School of Medicine, Chongqing University, Chongqing, 400044, China; Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Lei Wu
- Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Lei Wang
- College of Life Sciences, Xinyang Normal University, Xinyang, 464000, China.
| | - Yongsheng Li
- Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, China.
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4
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Rončević A, Koruga N, Soldo Koruga A, Rončević R, Rotim T, Šimundić T, Kretić D, Perić M, Turk T, Štimac D. Personalized Treatment of Glioblastoma: Current State and Future Perspective. Biomedicines 2023; 11:1579. [PMID: 37371674 DOI: 10.3390/biomedicines11061579] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Glioblastoma (GBM) is the most aggressive glial tumor of the central nervous system. Despite intense scientific efforts, patients diagnosed with GBM and treated with the current standard of care have a median survival of only 15 months. Patients are initially treated by a neurosurgeon with the goal of maximal safe resection of the tumor. Obtaining tissue samples during surgery is indispensable for the diagnosis of GBM. Technological improvements, such as navigation systems and intraoperative monitoring, significantly advanced the possibility of safe gross tumor resection. Usually within six weeks after the surgery, concomitant radiotherapy and chemotherapy with temozolomide are initiated. However, current radiotherapy regimens are based on population-level studies and could also be improved. Implementing artificial intelligence in radiotherapy planning might be used to individualize treatment plans. Furthermore, detailed genetic and molecular markers of the tumor could provide patient-tailored immunochemotherapy. In this article, we review current standard of care and possibilities of personalizing these treatments. Additionally, we discuss novel individualized therapeutic options with encouraging results. Due to inherent heterogeneity of GBM, applying patient-tailored treatment could significantly prolong survival of these patients.
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Affiliation(s)
- Alen Rončević
- Department of Neurosurgery, University Hospital Center Osijek, 31000 Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Nenad Koruga
- Department of Neurosurgery, University Hospital Center Osijek, 31000 Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Anamarija Soldo Koruga
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Neurology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Robert Rončević
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Tatjana Rotim
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Tihana Šimundić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Nephrology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Domagoj Kretić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Marija Perić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Cytology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Tajana Turk
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Damir Štimac
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Radiology, National Memorial Hospital Vukovar, 32000 Vukovar, Croatia
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Goryaynov SA, Buklina SB, Khapov IV, Batalov AI, Potapov AA, Pronin IN, Belyaev AU, Aristov AA, Zhukov VU, Pavlova GV, Belykh E. 5-ALA-guided tumor resection during awake speech mapping in gliomas located in eloquent speech areas: Single-center experience. Front Oncol 2022; 12:940951. [PMID: 36212421 PMCID: PMC9538677 DOI: 10.3389/fonc.2022.940951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Achieving maximal functionally safe resection of gliomas located within the eloquent speech areas is challenging, and there is a lack of literature on the combined use of 5-aminolevulinic acid (5-ALA) guidance and awake craniotomy. Objective The aim of this study was to describe our experience with the simultaneous use of 5-ALA fluorescence and awake speech mapping in patients with left frontal gliomas located within the vicinity of eloquent speech areas. Materials and methods A prospectively collected database of patients was reviewed. 5-ALA was administered at a dose of 20 mg/kg 2 h prior to operation, and an operating microscope in BLUE400 mode was used to visualize fluorescence. All patients underwent surgery using the "asleep-awake-asleep" protocol with monopolar and bipolar electrical stimulation to identify the proximity of eloquent cortex and white matter tracts and to guide safe limits of resection along with fluorescence guidance. Speech function was assessed by a trained neuropsychologist before, during, and after surgery. Results In 28 patients operated with cortical mapping and 5-ALA guidance (12 Grade 4, 6 Grade 3, and 10 Grade 2 gliomas), Broca's area was identified in 23 cases and Wernicke's area was identified in 5 cases. Fluorescence was present in 14 cases. Six tumors had residual fluorescence due to the positive speech mapping in the tumor bed. Transient aphasia developed in 14 patients, and permanent aphasia developed in 4 patients. In 6 patients operated with cortical and subcortical speech mapping and 5-ALA guidance (4 Grade 4, 1 Grade 3, and 1 Grade 2 gliomas), cortical speech areas were mapped in 5 patients and subcortical tracts were encountered in all cases. In all cases, resection was stopped despite the presence of residual fluorescence due to speech mapping findings. Transient aphasia developed in 6 patients and permanent aphasia developed in 4 patients. In patients with Grade 2-3 gliomas, targeted biopsy of focal fluorescence areas led to upgrading the grade and thus more accurate diagnosis. Conclusion 5-ALA guidance during awake speech mapping is useful in augmenting the extent of resection for infiltrative high-grade gliomas and identifying foci of anaplasia in non-enhancing gliomas, while maintaining safe limits of functional resection based on speech mapping. Positive 5-ALA fluorescence in diffuse Grade 2 gliomas may be predictive of a more aggressive disease course.
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Affiliation(s)
- Sergey A. Goryaynov
- Departments of Neurotraumatology and Neurooncology, N.N.Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Svetlana B. Buklina
- Departments of Neurotraumatology and Neurooncology, N.N.Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Ivan V. Khapov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Artyom I. Batalov
- Departments of Neurotraumatology and Neurooncology, N.N.Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Alexander A. Potapov
- Departments of Neurotraumatology and Neurooncology, N.N.Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Igor N. Pronin
- Departments of Neurotraumatology and Neurooncology, N.N.Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Artem U. Belyaev
- Departments of Neurotraumatology and Neurooncology, N.N.Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Andrey A. Aristov
- Departments of Neurotraumatology and Neurooncology, N.N.Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Vadim U. Zhukov
- Departments of Neurotraumatology and Neurooncology, N.N.Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Galina V. Pavlova
- Departments of Neurotraumatology and Neurooncology, N.N.Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Neurogenetics, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | - Evgenii Belykh
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, New Jersey, NJ, United States
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Interstitial Photodynamic Therapy for Glioblastomas: A Standardized Procedure for Clinical Use. Cancers (Basel) 2021; 13:cancers13225754. [PMID: 34830908 PMCID: PMC8616201 DOI: 10.3390/cancers13225754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary The most frequent primary high-grade brain tumors are glioblastomas (GBMs). The current standard of care for GBM is maximal surgical resection followed by radiotherapy and chemotherapy. Despite all these treatments, the overall survival is still limited, with a median of 15 months. The challenge is to improve the local control of this infiltrative disease. Interstitial photodynamic therapy (iPDT) is a minimally invasive treatment relying on the interaction of light, a photosensitizer and oxygen. It consists of introducing optical fibers inside the tumor to illuminate the cancer cells which have been sensitized to light thanks to a natural photosensitizer agent. Herein, we propose a standardized and reproducible workflow for the clinical application of iPDT to GBM. This workflow, which involves intraoperative imaging, a dedicated treatment planning system (TPS) and robotic assistance for the implantation of stereotactic optical fibers, represents a key step in the deployment of iPDT for the treatment of GBM. Abstract Glioblastomas (GBMs) are high-grade malignancies with a poor prognosis. The current standard of care for GBM is maximal surgical resection followed by radiotherapy and chemotherapy. Despite all these treatments, the overall survival is still limited, with a median of 15 months. For patients harboring inoperable GBM, due to the anatomical location of the tumor or poor general condition of the patient, the life expectancy is even worse. The challenge of managing GBM is therefore to improve the local control especially for non-surgical patients. Interstitial photodynamic therapy (iPDT) is a minimally invasive treatment relying on the interaction of light, a photosensitizer and oxygen. In the case of brain tumors, iPDT consists of introducing one or several optical fibers in the tumor area, without large craniotomy, to illuminate the photosensitized tumor cells. It induces necrosis and/or apoptosis of the tumor cells, and it can destruct the tumor vasculature and produces an acute inflammatory response that attracts leukocytes. Interstitial PDT has already been applied in the treatment of brain tumors with very promising results. However, no standardized procedure has emerged from previous studies. Herein, we propose a standardized and reproducible workflow for the clinical application of iPDT to GBM. This workflow, which involves intraoperative imaging, a dedicated treatment planning system (TPS) and robotic assistance for the implantation of stereotactic optical fibers, represents a key step in the deployment of iPDT for the treatment of GBM. This end-to-end procedure has been validated on a phantom in real operating room conditions. The thorough description of a fully integrated iPDT workflow is an essential step forward to a clinical trial to evaluate iPDT in the treatment of GBM.
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Checa-Chavarria E, Rivero-Buceta E, Sanchez Martos MA, Martinez Navarrete G, Soto-Sánchez C, Botella P, Fernández E. Development of a Prodrug of Camptothecin for Enhanced Treatment of Glioblastoma Multiforme. Mol Pharm 2021; 18:1558-1572. [PMID: 33645231 PMCID: PMC8482753 DOI: 10.1021/acs.molpharmaceut.0c00968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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A novel therapeutic approach for
glioblastoma multiforme (GBM)
therapy has been carried out through in vitro and in vivo testing by using the prodrug camptothecin-20-O-(5-aminolevulinate) (CPT-ALA). The incorporation of ALA
to CPT may promote uptake of the cytotoxic molecule by glioblastoma
cells where the heme synthesis pathway is active, improving the therapeutic
action and reducing the side effects over healthy tissue. The antitumor
properties of CPT-ALA have been tested on different GBM cell lines
(U87, U251, and C6) as well as in an orthotopic GBM model in rat,
where potential toxicity in central nervous system cells was analyzed. In vitro results indicated no significant differences in
the cytotoxic effect over the different GBM cell lines for CPT and
CPT-ALA, albeit cell mortality induced by CPT over normal cell lines
was significantly higher than CPT-ALA. Moreover, intracranial GBM
in rat was significantly reduced (30% volume) with 2 weeks of CPT-ALA
treatment with no significant side effects or alterations to the well-being
of the animals tested. 5-ALA moiety enhances CPT diffusion into tumors
due to solubility improvement and its metabolic-based targeting, increasing
the CPT cytotoxic effect on malignant cells while reducing CPT diffusion
to other proliferative healthy tissue. We demonstrate that CPT-ALA
blocks proliferation of GBM cells, reducing the infiltrative capacity
of GBM and promoting the success of surgical removal, which improves
life expectancy by reducing tumor recurrence.
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Affiliation(s)
- Elisa Checa-Chavarria
- Institute of Bioengineering, Universidad Miguel Hernández, Elche, Spain and Centre for Network Biomedical Research (CIBER-BBN), Avenida de la Universidad s/n, 03202 Elche, Spain
| | - Eva Rivero-Buceta
- Instituto de Tecnología Química, Universitat Politècnica de València-Consejo Superior de Investigaciones Científicas, Avenida de los Naranjos s/n, 46022 Valencia, Spain
| | - Miguel Angel Sanchez Martos
- Institute of Bioengineering, Universidad Miguel Hernández, Elche, Spain and Centre for Network Biomedical Research (CIBER-BBN), Avenida de la Universidad s/n, 03202 Elche, Spain
| | - Gema Martinez Navarrete
- Institute of Bioengineering, Universidad Miguel Hernández, Elche, Spain and Centre for Network Biomedical Research (CIBER-BBN), Avenida de la Universidad s/n, 03202 Elche, Spain
| | - Cristina Soto-Sánchez
- Institute of Bioengineering, Universidad Miguel Hernández, Elche, Spain and Centre for Network Biomedical Research (CIBER-BBN), Avenida de la Universidad s/n, 03202 Elche, Spain
| | - Pablo Botella
- Instituto de Tecnología Química, Universitat Politècnica de València-Consejo Superior de Investigaciones Científicas, Avenida de los Naranjos s/n, 46022 Valencia, Spain
| | - Eduardo Fernández
- Institute of Bioengineering, Universidad Miguel Hernández, Elche, Spain and Centre for Network Biomedical Research (CIBER-BBN), Avenida de la Universidad s/n, 03202 Elche, Spain
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Dupont C, Vermandel M, Leroy HA, Quidet M, Lecomte F, Delhem N, Mordon S, Reyns N. INtraoperative photoDYnamic Therapy for GliOblastomas (INDYGO): Study Protocol for a Phase I Clinical Trial. Neurosurgery 2020; 84:E414-E419. [PMID: 30053213 DOI: 10.1093/neuros/nyy324] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/17/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Glioblastoma (GBM) is characterized by marked proliferation, major infiltration, and poor prognosis. Despite current treatments, including surgery, radiation oncology, and chemotherapy, the overall median survival is 15 mo and the progression-free survival is 7 to 8 mo. Because of systematic relapse of the tumor, the improvement of local control remains an issue. In this context, photodynamic therapy (PDT) may offer a new treatment modality for GBM. OBJECTIVE To assess the feasibility of intraoperative PDT early after surgical resection of GBM without unacceptable and unexpected toxicities. METHODS The INDYGO clinical trial (INtraoperative photoDYnamic Therapy for GliOblastomas) treatment will be carried out in addition to the current standard of care (SOC) of glioblastoma: maximum resection surgery followed by concomitant radio-chemotherapy and adjuvant chemotherapy. PDT treatment will be delivered during surgery early, after the fluorescence-guided resection. Immunological responses and biomarkers will also be investigated during the follow-up. A total of 10 patients will be recruited during this study. EXPECTED OUTCOMES Clinical follow-up after the SOC with PDT is expected to be similar (no significant difference) to the SOC alone. DISCUSSION This INDYGO trial assesses the feasibility of intraoperative 5-aminolevulinic acid PDT, a novel seamless approach to treat GBM. The technology is easily embeddable within the reference treatment at a low-incremental cost. The safety of this new treatment modality is a preliminary requirement before a multicenter randomized clinical trial can be further conducted to assess local control improvement by treating infiltrating and nonresected GBM cells.
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Affiliation(s)
- Clément Dupont
- University of Lille, Inserm, CHU Lille, ONCO-THAI - Image Assisted Laser Therapy for Oncology, Lille, France
| | - Maximilien Vermandel
- University of Lille, Inserm, CHU Lille, ONCO-THAI - Image Assisted Laser Therapy for Oncology, Lille, France.,Department of Neurosurgery, University of Lille, CHU Lille, Lille, France
| | - Henri-Arthur Leroy
- University of Lille, Inserm, CHU Lille, ONCO-THAI - Image Assisted Laser Therapy for Oncology, Lille, France.,Department of Neurosurgery, University of Lille, CHU Lille, Lille, France
| | - Mathilde Quidet
- University of Lille, Inserm, CHU Lille, ONCO-THAI - Image Assisted Laser Therapy for Oncology, Lille, France.,Department of Neurosurgery, University of Lille, CHU Lille, Lille, France
| | - Fabienne Lecomte
- University of Lille, Inserm, CHU Lille, ONCO-THAI - Image Assisted Laser Therapy for Oncology, Lille, France
| | - Nadira Delhem
- Institut de biologie de Lille, Institut Pasteur de Lille, University of Lille, CNRS, Lille, France
| | - Serge Mordon
- University of Lille, Inserm, CHU Lille, ONCO-THAI - Image Assisted Laser Therapy for Oncology, Lille, France
| | - Nicolas Reyns
- University of Lille, Inserm, CHU Lille, ONCO-THAI - Image Assisted Laser Therapy for Oncology, Lille, France.,Department of Neurosurgery, University of Lille, CHU Lille, Lille, France
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9
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Potapov AA, Chobulov SA, Nikitin PV, Okhlopkov VA, Goryaynov SA, Kosyr'kova AV, Maryakhin AD, Chelushkin DM, Ryzhova MV, Zakharova NE, Batalov AI, Pronin IN, Danilov GV, Savel'eva TA, Loshchenov VB, Yashin KS, Chekhonin VP. [Intraoperative vascular fluorescence in cerebral glioblastomas and vascular histological features]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 83:21-34. [PMID: 32031165 DOI: 10.17116/neiro20198306121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
5-ALA intraoperative fluorescence is widely used in surgery of brain tumors for intraoperative demarcation of boundaries and more total resection because 5-ALA metabolites are not accumulated in the intact brain and vascular tissues. Given this fact, it was hypothesized that fluorescence of vessels in the immediate vicinity of a brain tumor may indicate their infiltration by tumor cells as a potential pathway for their dissemination and as a factor for continued tumor growth after surgery and adjuvant therapy. PURPOSE Identification of fluorescent vessels located near cerebral gliomas, with a histological description of their structure, relationships with the tumor, and potential invasion of the walls by tumor cells. MATERIAL AND METHODS A prospective cohort study included 14 patients with malignant supratentorial gliomas, aged 20 to 78 years. Five patients were operated on due to continued tumor growth. Two hours before surgery, all patients received 5-ALA orally. During surgery, a microscope (Carl Zeiss OPMI Pentero, Germany) with a fluorescent module (BLUE-400) was used. In all cases, molecular-genetic and immunohistochemical examinations of the tumor material were performed. During surgery, fluorescent vessels, after evaluating their functional significance, were also resected for histological examination. RESULTS Glioblastoma and anaplastic astrocytoma were verified in 10 and 4 patients, respectively. In 4 out of 10 glioblastoma cases, vessels with homogeneous or fragmentary fluorescent walls were detected in the tumor bed after resection of most of the tumor; in patients with anaplastic astrocytomas, vascular fluorescence was not observed. In the four vascular samples with intraoperatively detected wall fluorescence, tumor invasion into the vascular layers was revealed in all cases. These patients underwent an immunohistochemical examination with monoclonal antibodies to the glial GFAP marker, which clearly identified areas of ingrowth of tumor cells into the vascular wall. CONCLUSION 5-ALA intraoperative fluorescence is a fundamentally new approach in the rapid diagnosis of tumor-infiltrated blood vessels. Invasion of tumor cells to intact vessels may be a mechanism of tumor progression and dissemination. Additional resection of fluorescent vessels may affect the radicalness of surgical treatment, but requires a mandatory assessment of their functional significance.
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Affiliation(s)
- A A Potapov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - P V Nikitin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | | | | | | | - M V Ryzhova
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - A I Batalov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - G V Danilov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - T A Savel'eva
- Prokhorov Institute of General Physics, Moscow, Russia; MEPhI National Research Nuclear University, Moscow, Russia
| | - V B Loshchenov
- Prokhorov Institute of General Physics, Moscow, Russia; MEPhI National Research Nuclear University, Moscow, Russia
| | - K S Yashin
- Volga Federal Medical Research Center, Nizhniy Novgorod, Russia
| | - V P Chekhonin
- Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
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10
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Oberheim Bush NA, Hervey-Jumper SL, Berger MS. Management of Glioblastoma, Present and Future. World Neurosurg 2020; 131:328-338. [PMID: 31658576 DOI: 10.1016/j.wneu.2019.07.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 01/22/2023]
Abstract
Glioblastomas are the most common malignant brain tumor and despite extensive research have a dismal prognosis. This review focuses on the current treatment paradigms of glioblastoma and highlights current advances in surgical approaches, imaging techniques, molecular diagnostics, and translational efforts. Several promising clinical trials in immunotherapy and personalized medicine are discussed and the importance of quality of life in the patients and their caregivers both during active treatment and survivorship is also commented on.
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Affiliation(s)
- Nancy Ann Oberheim Bush
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Shawn L Hervey-Jumper
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, California, USA.
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11
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Zhang DY, Singhal S, Lee JYK. Optical Principles of Fluorescence-Guided Brain Tumor Surgery: A Practical Primer for the Neurosurgeon. Neurosurgery 2019; 85:312-324. [PMID: 30085129 DOI: 10.1093/neuros/nyy315] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 06/18/2018] [Indexed: 01/21/2023] Open
Abstract
Fluorescence-guided surgery is a rapidly growing field that has produced some of the most important innovations in surgical oncology in the past decade. These intraoperative imaging technologies provide information distinguishing tumor tissue from normal tissue in real time as the surgery proceeds and without disruption of the workflow. Many of these fluorescent tracers target unique molecular or cellular features of tumors, which offers the opportunity for identifying pathology with high precision to help surgeons achieve their primary objective of a maximal safe resection. As novel fluorophores and fluorescent probes emerge from preclinical development, a practical understanding of the principles of fluorescence remains critical for evaluating the clinical utility of these agents and identifying opportunities for further innovation. In this review, we provide an "in-text glossary" of the fundamental principles of fluorescence with examples of direct applications to fluorescence-guided brain surgery. We offer a detailed discussion of the various advantages and limitations of the most commonly used intraoperative imaging agents, including 5-aminolevulinic acid, indocyanine green, and fluorescein, with a particular focus on the photophysical properties of these specific agents as they provide a framework through which to understand the new agents that are entering clinical trials. To this end, we conclude with a survey of the fluorescent properties of novel agents that are currently undergoing or will soon enter clinical trials for the intraoperative imaging of brain tumors.
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Affiliation(s)
- Daniel Y Zhang
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sunil Singhal
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Y K Lee
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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12
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Picart T, Berhouma M, Dumot C, Pallud J, Metellus P, Armoiry X, Guyotat J. Optimization of high-grade glioma resection using 5-ALA fluorescence-guided surgery: A literature review and practical recommendations from the neuro-oncology club of the French society of neurosurgery. Neurochirurgie 2019; 65:164-177. [PMID: 31125558 DOI: 10.1016/j.neuchi.2019.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/17/2019] [Accepted: 04/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND When feasible, the surgical resection is the standard first step of the management of high-grade gliomas. 5-ALA fluorescence-guided-surgery (5-ALA-FGS) was developed to ease the intra-operative delineation of tumor borders in order to maximize the extent of resection. METHODS A Medline electronic database search was conducted. English language studies from January 1998 until July 2018 were included, following the PRISMA guidelines. RESULTS 5-ALA can be considered as a specific tool for the detection of tumor remnant but has a weaker sensibility (level 2). 5-ALA-FGS is associated with a significant increase in the rate of gross total resection reaching more than 90% in some series (level 1). Consistently, 5-ALAFGS improves progression-free survival (level 1). However, the gain in overall survival is more debated. The use of 5-ALA-FGS in eloquent areas is feasible but requires simultaneous intraoperative electrophysiologic functional brain monitoring to precisely locate and preserve eloquent areas (level 2). 5-ALA is usable during the first resection of a glioma but also at recurrence (level 2). From a practical standpoint, 5-ALA is orally administered 3 hours before the induction of anesthesia, the recommended dose being 20 mg/kg. Intra-operatively, the procedure is performed as usually with a central debulking and a peripheral dissection during which the surgeon switches from white to blue light. Provided that some precautions are observed, the technique does not expose the patient to particular complications. CONCLUSION Although 5-ALA-FGS contributes to improve gliomas management, there are still some limitations. Future methods will be developed to improve the sensibility of 5-ALA-FGS.
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Affiliation(s)
- T Picart
- Service de neurochirurgie D, hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron, France; Inserm 1052, UMR 5286,Team ATIP/AVENIR Transcriptomic diversity of stem cells, centre de cancérologie de Lyon, centre Léon-Bérard, 69008 Lyon, France.
| | - M Berhouma
- Service de neurochirurgie D, hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron, France; CREATIS Laboratory, Inserm U1206, UMR 5220, université de Lyon, 69100 Villeurbanne, France
| | - C Dumot
- Service de neurochirurgie D, hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron, France; CREATIS Laboratory, Inserm U1206, UMR 5220, université de Lyon, 69100 Villeurbanne, France
| | - J Pallud
- Département de neurochirurgie, hôpital Sainte-Anne, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75005 Paris, France; IMA-Brain, Inserm U894, institut de psychiatrie et neurosciences de Paris, 7013 Paris, France
| | - P Metellus
- Hôpital Privé Clairval, Ramsay général de santé, 13009 Marseille, France; UMR 7051, institut de neurophysiopathologie, université d'Aix-Marseille, 13344 Marseille, France
| | - X Armoiry
- MATEIS (Team I2B), University of Lyon, Lyon school of pharmacy, 69008 Lyon, France; Édouard-Herriot Hospital, Pharmacy Department, 69008 Lyon, France; University of Warwick, Warwick Medical School, Coventry, UK
| | - J Guyotat
- Service de neurochirurgie D, hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron, France
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13
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Sibai M, Wirth DJ, Leblond F, Roberts DW, Paulsen KD, Wilson BC. Quantitative subsurface spatial frequency-domain fluorescence imaging for enhanced glioma resection. JOURNAL OF BIOPHOTONICS 2019; 12:e201800271. [PMID: 30358162 PMCID: PMC6470016 DOI: 10.1002/jbio.201800271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/20/2018] [Accepted: 10/23/2018] [Indexed: 05/03/2023]
Abstract
The rate of complete resection of glioma has improved with the introduction of 5-aminolevulinic acid-induced protoporphyrin IX (PpIX) fluorescence image guidance. Surgical outcomes are further enhanced when the fluorescence signal is decoupled from the intrinsic tissue optical absorption and scattering obtained from diffuse reflectance measurements, yielding the absolute PpIX concentration, [PpIX]. Spatial frequency domain imaging was used previously to measure [PpIX] in near-surface tumors under blue fluorescence excitation. Here, we extend this to subsurface [PpIX] fluorescence under red-light excitation. The decay rate of the modulation amplitude of the fluorescence signal was used to calculate the PpIX depth, which was then applied in a forward diffusion model to estimate [PpIX] at depth. For brain-like optical properties in phantoms with PpIX fluorescent inclusions, the depth can be recovered up to depths of 9.5 mm ± 0.4 mm, with [PpIX] ranging from 5 to 15 μg/mL within an average deviation of 15% from the true [PpIX] value.
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Affiliation(s)
- Mira Sibai
- Princess Margaret Cancer Center/University Health Network, 101 College Street, Toronto, ON M5G 1L7 Canada, Canada
- Dept. of Medical Biophysics, University of Toronto, Faculty of Medicine, 101 College Street, Toronto, ON M5G 1L7 Canada
| | - Dennis J. Wirth
- Dartmouth College, Thayer School of Engineering, 14 Engineering Drive Hanover, NH USA 03755 USA
| | - Frederic Leblond
- Dept. of Engineering Physics, École Polytechnique De Montreal, 2900, boul. Édouard-Montpetit Montréal, Québec H3T 1J4 Canada
| | - David W. Roberts
- Dept. of Neurosurgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Keith D. Paulsen
- Dartmouth College, Thayer School of Engineering, 14 Engineering Drive Hanover, NH USA 03755 USA
| | - Brian C. Wilson
- Princess Margaret Cancer Center/University Health Network, 101 College Street, Toronto, ON M5G 1L7 Canada, Canada
- Dept. of Medical Biophysics, University of Toronto, Faculty of Medicine, 101 College Street, Toronto, ON M5G 1L7 Canada
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14
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Dupont C, Vermandel M, Reyns N, Mordon S. [Photodynamic therapy for the treatment of glioblastoma in neurosurgery]. Med Sci (Paris) 2018; 34:901-903. [PMID: 30526824 DOI: 10.1051/medsci/2018225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Clément Dupont
- Université de Lille, Inserm, CHU de Lille, U1189 - ONCO-THAI - Thérapies laser assistées par l'image pour l'oncologie, 59000 Lille, France
| | - Maximilien Vermandel
- Université de Lille, Inserm, CHU de Lille, U1189 - ONCO-THAI - Thérapies laser assistées par l'image pour l'oncologie, 59000 Lille, France - Service de neurochirurgie, CHU de Lille, 59000 Lille, France
| | - Nicolas Reyns
- Université de Lille, Inserm, CHU de Lille, U1189 - ONCO-THAI - Thérapies laser assistées par l'image pour l'oncologie, 59000 Lille, France - Service de neurochirurgie, CHU de Lille, 59000 Lille, France
| | - Serge Mordon
- Université de Lille, Inserm, CHU de Lille, U1189 - ONCO-THAI - Thérapies laser assistées par l'image pour l'oncologie, 59000 Lille, France
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15
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Kröger S, Niehoff AC, Jeibmann A, Sperling M, Paulus W, Stummer W, Karst U. Complementary Molecular and Elemental Mass-Spectrometric Imaging of Human Brain Tumors Resected by Fluorescence-Guided Surgery. Anal Chem 2018; 90:12253-12260. [PMID: 30215510 DOI: 10.1021/acs.analchem.8b03516] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Fluorescence-guided surgery (FGS) has been established as a powerful technique for glioblastoma resection. After oral application of the prodrug 5-aminolevulinic acid (5-ALA), protoporphyrin IX (PpIX) is formed as an intermediate of the heme-biosynthesis cascade and accumulates within the tumor. By intraoperative fluorescence microscopy, the specific PpIX fluorescence can be used to differentiate the tumor from healthy brain tissue. To investigate possible limitations of fluorescence diagnosis, the complementary use of molecular and elemental mass-spectrometry imaging (MSI) is presented. Matrix-assisted laser-desorption-ionization mass spectrometry (MALDI-MS) is used to examine the distribution of PpIX and heme b in human brain tumors. MALDI-MS/MS imaging is performed to validate MS data and improve the signal-to-noise ratio (S/N). Comparing the imaging results with histological evaluation, increased PpIX accumulation in areas of high tumor-cell density is observed. Heme b accumulation are only found in areas of blood vessels and hemorrhage, confirming the hampered transformation from PpIX to heme b in glioblastoma tissue. Investigation of non-neoplastic brain tissue and glioblastoma resected without external 5-ALA administration as control samples with true-negative fluorescence verified the absence of PpIX accumulation. Analysis of necrotic tumor tissue and gliosarcoma, one rare type of glioma appearing nonfluorescent during FGS, as case examples with false-negative-fluorescence diagnosis, revealed the absence of significant amounts of PpIX, indicating an impairment of PpIX formation. Molecular analysis is complemented by quantitative laser ablation-inductively coupled plasma (LA-ICP) MSI correlating heme b and Fe distribution. Mathematical pixel-by-pixel correlation of molecular and elemental data revealed a positive correlation with heteroscedasticity for the spatially resolved heme b signal intensities and Fe concentrations.
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Affiliation(s)
- Sabrina Kröger
- Institute of Inorganic and Analytical Chemistry , University of Münster , Corrensstraße 30 , 48149 Münster , Germany
| | - Ann-Christin Niehoff
- Institute of Inorganic and Analytical Chemistry , University of Münster , Corrensstraße 30 , 48149 Münster , Germany
| | - Astrid Jeibmann
- Institute of Neuropathology , University Hospital Münster , Pottkamp 2 , 48149 Münster , Germany
| | - Michael Sperling
- Institute of Inorganic and Analytical Chemistry , University of Münster , Corrensstraße 30 , 48149 Münster , Germany.,European Virtual Institute for Speciation Analysis (EVISA) , Mendelstraße 11 , 48149 Münster , Germany
| | - Werner Paulus
- Institute of Neuropathology , University Hospital Münster , Pottkamp 2 , 48149 Münster , Germany
| | - Walter Stummer
- Department of Neurosurgery , University Hospital Münster , Albert-Schweitzer-Campus 1 , 48149 Münster , Germany
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry , University of Münster , Corrensstraße 30 , 48149 Münster , Germany
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16
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Xiao Q, Chen T, Chen S. Fluorescent contrast agents for tumor surgery. Exp Ther Med 2018; 16:1577-1585. [PMID: 30186374 PMCID: PMC6122374 DOI: 10.3892/etm.2018.6401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 04/13/2018] [Indexed: 02/06/2023] Open
Abstract
Cancer is a leading cause of cases of mortality worldwide. The most effective method to cure solid tumors is surgery. Every year, >50% of cancer patients receive surgery to remove solid tumors. Surgery may increase the cure rate of most solid tumors by 4–11 fold. Surgery has many challenges, including identifying small lesions, locating metastases and confirming complete tumor removal. Fluorescence guidance describes a new approach to improve surgical accuracy. Near-infrared fluorescence imaging allows for real-time early diagnosis and intraoperative imaging of lesion tissue. The results of previous preclinical studies in the field of near-infrared fluorescence imaging are promising. This review provides examples introducing the three kinds of fluorescent dyes: The passive fluorescent dye indocyanine green, which has been approved by the Food and Drug Administration for clinical use in the USA, the fluorescent prodrug 5-aminolevulinic acid, a porphyrin precursor in the heme synthesis, and biomarker-targeted fluorescent dyes, which allow conjugation to different target sites.
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Affiliation(s)
- Qi Xiao
- School of Life Science, Nanjing Normal University, Nanjing, Jiangsu 210046, P.R. China
| | - Tianming Chen
- Department of Surgery, Nanjing Medical University Third Affiliated Hospital, Nanjing, Jiangsu 211166, P.R. China
| | - Shilin Chen
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, Jiangsu 210009, P.R. China
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17
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Rowland MJ, Parkins CC, McAbee JH, Kolb AK, Hein R, Loh XJ, Watts C, Scherman OA. An adherent tissue-inspired hydrogel delivery vehicle utilised in primary human glioma models. Biomaterials 2018; 179:199-208. [PMID: 30037456 DOI: 10.1016/j.biomaterials.2018.05.054] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 11/17/2022]
Abstract
A physical hydrogel cross-linked via the host-guest interactions of cucurbit[8]uril and utilised as an implantable drug-delivery vehicle for the brain is described herein. Constructed from hyaluronic acid, this hydrogel is biocompatible and has a high water content of 98%. The mechanical properties have been characterised by rheology and compared with the modulus of human brain tissue demonstrating the production of a soft material that can be moulded into the cavity it is implanted into following surgical resection. Furthermore, effective delivery of therapeutic compounds and antibodies to primary human glioblastoma cell lines is showcased by a variety of in vitro and ex vivo viability and immunocytochemistry based assays.
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Affiliation(s)
- Matthew J Rowland
- Melville Laboratory for Polymer Synthesis, Department of Chemistry, University of Cambridge, Cambridge, CB2 1EW, UK
| | - Christopher C Parkins
- Melville Laboratory for Polymer Synthesis, Department of Chemistry, University of Cambridge, Cambridge, CB2 1EW, UK
| | - Joseph H McAbee
- Department of Clinical Neurosciences, Cambridge Centre for Brain Repair, University of Cambridge, Cambridge, CB2 0PY, UK
| | - Anna K Kolb
- Department of Clinical Neurosciences, Cambridge Centre for Brain Repair, University of Cambridge, Cambridge, CB2 0PY, UK
| | - Robert Hein
- Melville Laboratory for Polymer Synthesis, Department of Chemistry, University of Cambridge, Cambridge, CB2 1EW, UK
| | - Xian Jun Loh
- Institute of Materials Research and Engineering, A*STAR, 2 Fusionopolis Way, Innovis, Singapore
| | - Colin Watts
- Department of Clinical Neurosciences, Cambridge Centre for Brain Repair, University of Cambridge, Cambridge, CB2 0PY, UK; Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Oren A Scherman
- Melville Laboratory for Polymer Synthesis, Department of Chemistry, University of Cambridge, Cambridge, CB2 1EW, UK.
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18
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Leroy HA, Delmaire C, Le Rhun E, Drumez E, Lejeune JP, Reyns N. High-field intraoperative MRI in glioma surgery: A prospective study with volumetric analysis of extent of resection and functional outcome. Neurochirurgie 2018; 64:155-160. [PMID: 29754739 DOI: 10.1016/j.neuchi.2018.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/14/2018] [Accepted: 02/17/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND High-field intraoperative MRI (IoMRI) is a useful tool to improve the extent of glioma resection (EOR). OBJECTIVE To compare the interest of 1.5T IoMRI in glioma surgery between enhancing and non-enhancing tumors, based on volumetric analysis. METHODS A prospective single-center study included consecutive adult patients undergoing glioma surgery with IoMRI. Volumetric evaluation was based on FLAIR hypersignal after gadolinium injection in non-enhancing tumors and T1 hypersignal after gadolinium injection in enhancing tumors. Endpoints comprised: residual tumor volume (RTV), EOR, workflow and clinical outcome on Karnofsky performance score (KPS). RESULTS Fifty-three surgeries were performed from July 2014 to January 2016. Thirty-four patients underwent one IoMRI, and 19 two IoMRIs. In non-enhancing tumors, intraoperative RTV on 1st IoMRI T2/FLAIR was higher than in enhancing tumors on T1 sequences (7.25cm3 vs. 0.74cm3, respectively; P=0.008), whereas the RTV on 2nd IoMRIs and final RTV were no longer significantly different. After IoMRI, 72% of patients underwent additional resection. In non-enhancing tumors, EOR increased from 77.3% on 1st IoMRI to 97.4% on last MRI (P<0.001). Taking all tumors together, final RTV values were: median=0cm3, mean=3.9cm3. Mean final EOR was 94%. In 25% of patients, KPS was reduced during early postoperative course; at 3 and 6 months postoperatively, median KPS was 90. CONCLUSION Intraoperative MRI guidance significantly enhanced the extent of glioma resection, especially for non- or minimally enhancing tumors, while preserving patient autonomy.
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Affiliation(s)
- H-A Leroy
- Department of Neurosurgery and Neuro-Oncology, CHU de Lille, 59000 Lille, France; Inserm, U1189 - ONCO-THAI - Image-Assisted Laser Therapy for Oncology, University Lille, CHU de Lille, 59000 Lille, France.
| | - C Delmaire
- Department of Radiology, CHU de Lille, 59000 Lille, France
| | - E Le Rhun
- Department of Neurosurgery and Neuro-Oncology, CHU de Lille, 59000 Lille, France
| | - E Drumez
- EA 2694-santé publique : epidémiologie et qualité des soins, Department of Biostatistics, CHU de Lille, University Lille, 59000 Lille, France
| | - J-P Lejeune
- Department of Neurosurgery and Neuro-Oncology, CHU de Lille, 59000 Lille, France
| | - N Reyns
- Department of Neurosurgery and Neuro-Oncology, CHU de Lille, 59000 Lille, France; Inserm, U1189 - ONCO-THAI - Image-Assisted Laser Therapy for Oncology, University Lille, CHU de Lille, 59000 Lille, France
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19
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Haj A, Doenitz C, Schebesch KM, Ehrensberger D, Hau P, Putnik K, Riemenschneider MJ, Wendl C, Gerken M, Pukrop T, Brawanski A, Proescholdt MA. Extent of Resection in Newly Diagnosed Glioblastoma: Impact of a Specialized Neuro-Oncology Care Center. Brain Sci 2017; 8:brainsci8010005. [PMID: 29295569 PMCID: PMC5789336 DOI: 10.3390/brainsci8010005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/07/2017] [Accepted: 12/19/2017] [Indexed: 02/05/2023] Open
Abstract
Treatment of glioblastoma (GBM) consists of microsurgical resection followed by concomitant radiochemotherapy and adjuvant chemotherapy. The best outcome regarding progression free (PFS) and overall survival (OS) is achieved by maximal resection. The foundation of a specialized neuro-oncology care center (NOC) has enabled the implementation of a large technical portfolio including functional imaging, awake craniotomy, PET scanning, fluorescence-guided resection, and integrated postsurgical therapy. This study analyzed whether the technically improved neurosurgical treatment structure yields a higher rate of complete resection, thus ultimately improving patient outcome. Patients and methods: The study included 149 patients treated surgically for newly diagnosed GBM. The neurological performance score (NPS) and the Karnofsky performance score (KPS) were measured before and after resection. The extent of resection (EOR) was volumetrically quantified. Patients were stratified into two subcohorts: treated before (A) and after (B) the foundation of the Regensburg NOC. The EOR and the PFS and OS were evaluated. Results: Prognostic factors for PFS and OS were age, preoperative KPS, O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation status, isocitrate dehydrogenase 1 (IDH1) mutation status and EOR. Patients with volumetrically defined complete resection had significantly better PFS (9.4 vs. 7.8 months; p = 0.042) and OS (18.4 vs. 14.5 months; p = 0.005) than patients with incomplete resection. The frequency of transient or permanent postoperative neurological deficits was not higher after complete resection in both subcohorts. The frequency of complete resection was significantly higher in subcohort B than in subcohort A (68.2% vs. 34.8%; p = 0.007). Accordingly, subcohort B showed significantly longer PFS (8.6 vs. 7.5 months; p = 0.010) and OS (18.7 vs. 12.4 months; p = 0.001). Multivariate Cox regression analysis showed complete resection, age, preoperative KPS, and MGMT promoter status as independent prognostic factors for PFS and OS. Our data show a higher frequency of complete resection in patients with GBM after the establishment of a series of technical developments that resulted in significantly better PFS and OS without increasing surgery-related morbidity.
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Affiliation(s)
- Amer Haj
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Christian Doenitz
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Karl-Michael Schebesch
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Denise Ehrensberger
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Peter Hau
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neurology, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Kurt Putnik
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Radiation Oncology, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Markus J Riemenschneider
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neuropathology, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Christina Wendl
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neuroradiology, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Michael Gerken
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Tumor Center Regensburg, Institute of Quality Assurance and Health Services Research, University of Regensburg, 93053 Regensburg, Germany.
| | - Tobias Pukrop
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Hematology and Oncology, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Alexander Brawanski
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Martin A Proescholdt
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
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Nakano Y, Nakata K, Shibata S, Heishima Y, Nishida H, Sakai H, Yano H, Kamishina H. Fluorescein sodium-guided resection of intracranial lesions in 22 dogs. Vet Surg 2017; 47:302-309. [PMID: 29247539 DOI: 10.1111/vsu.12763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/29/2017] [Accepted: 08/10/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the safety of an intraoperative fluorescein sodium (FS) injection and elucidate the relationships between the MRI findings, pathological diagnoses, and intraoperative staining characteristics of intracranial lesions in 22 dogs. STUDY DESIGN Prospective case series. ANIMALS Twenty-two dogs with intracranial lesions. METHODS FS was intravenously administered to 22 dogs undergoing craniotomy for suspected intracranial tumors to evaluate perioperative and postoperative adverse effects. The intensities and patterns of gadolinium (Gd) enhancement on preoperative magnetic resonance imaging and intraoperative FS staining were graded, and their relationship was evaluated. Intraoperative FS staining characteristics and pathological diagnoses were compared. RESULTS The only adverse effect noted was repetitive vomiting in 2 dogs. The intensities and patterns between preoperative Gd enhancement and intraoperative FS staining appeared to agree. High-grade glioma and histiocytic sarcoma had more intense FS staining. Lesions with strong Gd enhancement, including meningiomas and choroid plexus tumors, also had intense FS staining. CONCLUSION The intraoperative use of FS is a simple and safe technique to guide the resection of intracranial lesions in dogs. The findings on Gd enhancement, FS staining, and histopathology appeared to agree but require validation in a larger set of cases. CLINICAL SIGNIFICANCE The intraoperative use of FS may improve the prognosis of dogs with brain tumors by guiding the resection of lesions.
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Affiliation(s)
- Yukiko Nakano
- The Animal Medical Center of Gifu University, Gifu University, Gifu, Japan
| | - Kohei Nakata
- The Animal Medical Center of Gifu University, Gifu University, Gifu, Japan.,The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan
| | - Sanae Shibata
- The Animal Medical Center of Gifu University, Gifu University, Gifu, Japan.,The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan.,Joint Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan
| | | | - Hidetaka Nishida
- The Animal Medical Center of Gifu University, Gifu University, Gifu, Japan.,The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan.,Joint Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan
| | - Hiroki Sakai
- The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan.,Joint Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan.,Center for Highly Advanced Integration of Nano and Life Sciences, Gifu University, Gifu, Japan
| | - Hirohito Yano
- Department of Neurosurgery, Gifu University School of Medicine, Gifu, Japan
| | - Hiroaki Kamishina
- The Animal Medical Center of Gifu University, Gifu University, Gifu, Japan.,The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan.,Joint Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan.,Center for Highly Advanced Integration of Nano and Life Sciences, Gifu University, Gifu, Japan
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Dupont C, Mordon S, Deleporte P, Reyns N, Vermandel M. A novel device for intraoperative photodynamic therapy dedicated to glioblastoma treatment. Future Oncol 2017; 13:2441-2454. [PMID: 28942677 DOI: 10.2217/fon-2017-0261] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Photodynamic therapy (PDT) appears to be a valuable new treatment modality for cancer therapy. Studies have reported successful application of PDT for glioblastoma. Here, we introduce a new device dedicated to intraoperative PDT delivered early after fluoro-guided resection combined with a transfer function that determines the treatment time based on the size of the surgical resection cavity. MATERIALS & METHODS First, we describe the device, which is composed of a trocar, a balloon filled with a diffusing solution, and a fiber guide in which a cylindrical light diffuser is inserted. Ex vivo experiments were performed to measure the fluence rate inside biological tissues. A calibration factor was defined to convert power measurements into fluence rate values. Calf brains were used to simulate light propagation in human brain tissue, and the photosensitizer administration effect on optical properties was discussed. The temperature elevation during illumination was evaluated. RESULTS Light power was measured in tissues surrounding the device during ex vivo experiments. Using the previously characterized calibration factor, power measurements were converted to fluence rate values to obtain the transfer function. No thermal elevation was observed during a 2-h temperature test, and the impact of protoporphyrin IX on brain optical properties was considered negligible. CONCLUSION A discussion of experimental precision is presented. The light duration determined by the abacus had a standard deviation of <1 min. This value is weak compared with the total illumination time necessary to treat one patient. The main advantage of our device lies in its straightforward implementation of intraoperative PDT for neurosurgery with acceptable dosimetry and easy treatment time.
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Affiliation(s)
- Clément Dupont
- Univ. Lille, Inserm, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Serge Mordon
- Univ. Lille, Inserm, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Pascal Deleporte
- Univ. Lille, Inserm, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Nicolas Reyns
- Univ. Lille, Inserm, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Maximilien Vermandel
- Univ. Lille, Inserm, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
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22
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Dupont C, Vignion A, Mordon S, Reyns N, Vermandel M. Photodynamic therapy for glioblastoma: A preliminary approach for practical application of light propagation models. Lasers Surg Med 2017; 50:523-534. [DOI: 10.1002/lsm.22739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Clément Dupont
- Univ. Lille, Inserm, CHU Lille, U1189‐ONCO‐THAI‐Image Assisted Laser Therapy for OncologyLilleF‐59000France
| | - Anne‐Sophie Vignion
- Univ. Lille, Inserm, CHU Lille, U1189‐ONCO‐THAI‐Image Assisted Laser Therapy for OncologyLilleF‐59000France
| | - Serge Mordon
- Univ. Lille, Inserm, CHU Lille, U1189‐ONCO‐THAI‐Image Assisted Laser Therapy for OncologyLilleF‐59000France
| | - Nicolas Reyns
- Univ. Lille, Inserm, CHU Lille, U1189‐ONCO‐THAI‐Image Assisted Laser Therapy for OncologyLilleF‐59000France
| | - Maximilien Vermandel
- Univ. Lille, Inserm, CHU Lille, U1189‐ONCO‐THAI‐Image Assisted Laser Therapy for OncologyLilleF‐59000France
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23
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Richter JCO, Haj-Hosseini N, Hallbeck M, Wårdell K. Combination of hand-held probe and microscopy for fluorescence guided surgery in the brain tumor marginal zone. Photodiagnosis Photodyn Ther 2017; 18:185-192. [PMID: 28223144 DOI: 10.1016/j.pdpdt.2017.01.188] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/23/2016] [Accepted: 01/03/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Visualization of the tumor is crucial for differentiating malignant tissue from healthy brain during surgery, especially in the tumor marginal zone. The aim of the study was to introduce a fluorescence spectroscopy-based hand-held probe (HHF-probe) for tumor identification in combination with the fluorescence guided resection surgical microscope (FGR-microscope), and evaluate them in terms of diagnostic performance and practical aspects of fluorescence detection. MATERIAL AND METHODS Eighteen operations were performed on 16 patients with suspected high-grade glioma. The HHF-probe and the FGR-microscope were used for detection of protoporphyrin (PpIX) fluorescence induced by 5-aminolevulinic acid (5-ALA) and evaluated against histopathological analysis and visual grading done through the FGR-microscope by the surgeon. A ratio of PpIX fluorescence intensity to the autofluorescence intensity (fluorescence ratio) was used to quantify the spectra detected by the probe. RESULTS Fluorescence ratio medians (range 0 - 40) measured by the probe were related to the intensity of the fluorescence in the FGR-microscope, categorized as "none" (0.3, n=131), "weak" (1.6, n=34) and "strong" (5.4, n=28). Of 131 "none" points in the FGR-microscope, 88 (67%) exhibited fluorescence with the HHF-probe. For the tumor marginal zone, the area under the receiver operator characteristics (ROC) curve was 0.49 for the FGR-microscope and 0.65 for the HHF-probe. CONCLUSIONS The probe was integrated in the established routine of tumor resection using the FGR-microscope. The HHF-probe was superior to the FGR-microscope in sensitivity; it detected tumor remnants after debulking under the FGR-microscope. The combination of the HHF-probe and the FGR-microscope was beneficial especially in the tumor marginal zone.
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Affiliation(s)
- Johan C O Richter
- Department of Biomedical Engineering, Linköping University, Sweden; Department of Neurosurgery Linköping University Hospital, Region Östergötland, Linköping, Sweden.
| | | | - Martin Hallbeck
- Department of Clinical Pathology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Karin Wårdell
- Department of Biomedical Engineering, Linköping University, Sweden
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25
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5-ALA Photodynamic Therapy in Neurosurgery, Towards the Design of a Treatment Planning System: A Proof of Concept. Ing Rech Biomed 2017. [DOI: 10.1016/j.irbm.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Li H, Xu Y, Shi W, Li F, Zeng Q, Yi C. Assessment of alterations in X-ray irradiation-induced DNA damage of glioma cells by using proton nuclear magnetic resonance spectroscopy. Int J Biochem Cell Biol 2017; 84:109-118. [PMID: 28122253 DOI: 10.1016/j.biocel.2017.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/15/2017] [Accepted: 01/18/2017] [Indexed: 12/25/2022]
Abstract
Glioma is one of the most common types of brain tumors. DNA damage is closely associated with glioma cell apoptosis induced by X-ray irradiation. Alterations of metabolites in glioma can be detected noninvasively by proton nuclear magnetic resonance (1H NMR) spectroscopy. To noninvasively explore the micro mechanism in X-ray irradiation-induced apoptosis, the relationship between metabolites and DNA damage in glioma cells was investigated. Three glioma cell lines (C6, U87 and U251) were randomly designated as control (0Gy) and treatment groups (1, 5, 10, 15Gy). After X-ray exposure, each group was separated into four parts: (i) to detect metabolites by 1H NMR spectroscopy; (ii) to make cell colonies; (iii) to detect cell cycle distribution and apoptosis rate by flow cytometry; and (iv) to measure DNA damage by comet assay. The metabolite ratios of lactate/creatine and succinate/creatine decreased (lactate/creatine: C6, 22.17-66.27%; U87, 15.93-44.56%; U251, 26.27-74.48%. succinate/creatine: C6, 14.41-48.35%; U87, 22.03-70.62%; U251, 17.33-60.06%) and choline/creatine increased (C6, 52.22-389.68%; U87, 56.15-82.36%; U251, 31.87-278.62%) in the treatment groups compared with the control group (each P<0.05), which linearly depended on DNA damage. An increasing dose of X-ray irradiation increased numbers of apoptotic cells (P<0.01), and the DNA damage parameters were dose-dependent (P<0.05). The colony-forming rate declined (P<0.01) and the percentage of cells at G1 stage increased when exposed to 1Gy X-ray (three cell lines, P<0.05). Metabolite alterations detected by 1H NMR spectroscopy can be used to determine DNA damage induced by X-ray irradiation. 1H NMR spectroscopy is a noninvasive method to predict DNA damage of glioma cell at the micro level.
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Affiliation(s)
- Hongxia Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yanjie Xu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Wenqi Shi
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Fuyan Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Qingshi Zeng
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China.
| | - Cui Yi
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
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28
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Current and future strategies for treatment of glioma. Neurosurg Rev 2016; 40:1-14. [PMID: 27085859 DOI: 10.1007/s10143-016-0709-8] [Citation(s) in RCA: 359] [Impact Index Per Article: 44.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/25/2016] [Indexed: 01/12/2023]
Abstract
Gliomas are one of the most common types of primary brain tumors and have remained particularly challenging to treat. This review illustrates a multidisciplinary approach to the treatment of glioma and glioblastoma. We will review current advances in surgical approaches, novel imaging techniques, advanced molecular characterization of tumors and translational efforts for treatment. We will focus on current clinical trials as well as the pursuit of personalized or precision therapy. We will also comment on the importance of both quality of life of our patients and their care givers.
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Ha Y, Choi HK. Recent conjugation strategies of small organic fluorophores and ligands for cancer-specific bioimaging. Chem Biol Interact 2016; 248:36-51. [DOI: 10.1016/j.cbi.2016.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/02/2016] [Accepted: 02/08/2016] [Indexed: 01/03/2023]
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