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Sarkis HM, Zawy Alsofy S, Stroop R, Lewitz M, Schipmann S, Unnewehr M, Paulus W, Nakamura M, Ewelt C. Does 5-ALA Fluorescence Microscopy Improve Complete Resectability in Cerebral/Cerebellar Metastatic Surgery? A Retrospective Data Analysis from a Cranial Center. Cancers (Basel) 2024; 16:2242. [PMID: 38927947 PMCID: PMC11201798 DOI: 10.3390/cancers16122242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/18/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: In this study, the intraoperative fluorescence behavior of brain metastases after the administration of 5-aminolevulinic acid (5-ALA) was analyzed. The aim was to investigate whether the resection of brain metastases using 5-ALA fluorescence also leads to a more complete resections and thus to a prolongation of survival; (2) Methods: The following variables have been considered: age, sex, number of metastases, localization, involvement of eloquent area, correlation between fluorescence and primary tumor/subtype, resection, and survival time. The influence on the degree of resection was determined with a control MRI within the first three postoperative days; (3) Results: Brain metastases fluoresced in 57.5% of cases. The highest fluorescence rates of 73.3% were found in breast carcinoma metastases and the histologic subtype adenocarcinoma (68.1%). No correlation between fluorescence behavior and localization, primary tumor, or histological subtype was found. Complete resection was detected in 82.5%, of which 56.1% were fluorescence positive. There was a trend towards improved resectability (increase of 12.1%) and a significantly longer survival time (p = 0.009) in the fluorescence-positive group; (4) Conclusions: 5-ALA-assisted extirpation leads to a more complete resection and longer survival and can therefore represent a low-risk addition to modern surgery for brain metastases.
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Affiliation(s)
- Hraq Mourad Sarkis
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (H.M.S.); (R.S.); (M.L.); (M.U.)
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfaelische Wilhelms-University Muenster, 59073 Hamm, Germany;
- Department of Neurosurgery, St. Marien-Hospital, Academic Hospital of the Hannover Medical School, 49076 Osnabrueck, Germany
| | - Samer Zawy Alsofy
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (H.M.S.); (R.S.); (M.L.); (M.U.)
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfaelische Wilhelms-University Muenster, 59073 Hamm, Germany;
| | - Ralf Stroop
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (H.M.S.); (R.S.); (M.L.); (M.U.)
| | - Marc Lewitz
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (H.M.S.); (R.S.); (M.L.); (M.U.)
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfaelische Wilhelms-University Muenster, 59073 Hamm, Germany;
| | - Stephanie Schipmann
- Department of Neurosurgery, University Hospital Muenster, 48149 Muenster, Germany;
| | - Markus Unnewehr
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (H.M.S.); (R.S.); (M.L.); (M.U.)
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Muenster, 48149 Muenster, Germany;
| | - Makoto Nakamura
- Department of Neurosurgery, Academic Hospital Koeln-Merheim, Witten/Herdecke University, 51109 Koeln, Germany;
| | - Christian Ewelt
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfaelische Wilhelms-University Muenster, 59073 Hamm, Germany;
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Pevná V, Huntošová V. Imaging of heterogeneity in 3D spheroids of U87MG glioblastoma cells and its implications for photodynamic therapy. Photodiagnosis Photodyn Ther 2023; 44:103821. [PMID: 37778715 DOI: 10.1016/j.pdpdt.2023.103821] [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: 07/25/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND In recent years, pharmacology and toxicology have emphasised the intention to move from in vivo models to simplified 3D objects represented by spheroidal models of cancer. Mitochondria are one of the subcellular organelles responsible for cell metabolism and are often a lucrative target for cancer treatment including photodynamic therapy (PDT). METHODS Hanging droplet-grown glioblastoma cells were forced to form spheroids with heterogeneous environments that were characterised by fluorescence microscopy and flow cytometry using fluorescent probes sensitive to oxidative stress and apoptosis. PDT was induced with hypericin at 590 nm. RESULTS It was found that the metabolic activity of the cells in the periphery and core of the spheroid was different. Higher oxidative stress and induction of caspase-3 were observed in the peripheral layers after PDT. These parts were more destabilised and showed higher expression of LC3B, an autophagic marker. However, the response of the whole system to the treatment was controlled by the cells in the core of the spheroids, which were hardly affected by the treatment. It has been shown that the depth of penetration of hypericin into this system is an important limiting step for PDT and the induction of autophagy and apoptosis. CONCLUSIONS In this work, we have described the fluorescence imaging of vital mitochondria, caspase-3 production and immunostaining of autophagic LC3B in cells from glioblastoma spheroids before and after PDT. Overall, we can conclude that this model represents an in vitro and in vivo applicable alternative for the study of PDT in solid microtumours.
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Affiliation(s)
- Viktória Pevná
- Department of Biophysics, Institute of Physics, Faculty of Science, P.J. Šafárik University in Košice, Jesenná 5, Košice SK-041 54, Slovakia
| | - Veronika Huntošová
- Center for Interdisciplinary Biosciences, Technology and Innovation Park, P.J. Šafárik University in Košice, Jesenná 5, Košice SK-041 54, Slovakia; Institute of Animal Biochemistry and Genetics, Centre of Biosciences, Slovak Academy of Sciences, Dubravska cesta 9, Bratislava 840 05, Slovakia.
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Inoue A, Ohnishi T, Nishikawa M, Watanabe H, Kusakabe K, Taniwaki M, Yano H, Ohtsuka Y, Matsumoto S, Suehiro S, Yamashita D, Shigekawa S, Takahashi H, Kitazawa R, Tanaka J, Kunieda T. Identification of CD44 as a Reliable Biomarker for Glioblastoma Invasion: Based on Magnetic Resonance Imaging and Spectroscopic Analysis of 5-Aminolevulinic Acid Fluorescence. Biomedicines 2023; 11:2369. [PMID: 37760811 PMCID: PMC10525185 DOI: 10.3390/biomedicines11092369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Recurrent glioblastoma multiforme (GBM) is largely attributed to peritumoral infiltration of tumor cells. As higher CD44 expression in the tumor periphery correlates with higher risk of GBM invasion, the present study analyzed the relationship between CD44 expression and magnetic resonance imaging (MRI)-based invasiveness of GBM on a large scale. We also quantitatively evaluated GBM invasion using 5-aminolevulinic acid (5-ALA) spectroscopy to investigate the relationship between CD44 expression and tumor invasiveness as evaluated by intraoperative 5-ALA intensity. Based on MRI, GBM was classified as high-invasive type in 28 patients and low-invasive type in 22 patients. High-invasive type expressed CD44 at a significantly higher level than low-invasive type and was associated with worse survival. To quantitatively analyze GBM invasiveness, the relationship between tumor density in the peritumoral area and the spectroscopic intensity of 5-ALA was investigated. Spectroscopy showed that the 5-ALA intensity of infiltrating tumor cells correlated with tumor density as represented by the Ki-67 staining index. No significant correlation between CD44 and degree of 5-ALA-based invasiveness of GBM was found, but invasiveness of GBM as evaluated by 5-ALA matched the classification from MRI in all except one case, indicating that CD44 expression at the GBM periphery could provide a reliable biomarker for invasiveness in GBM.
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Affiliation(s)
- Akihiro Inoue
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan; (M.N.); (H.W.); (K.K.); (Y.O.); (S.M.); (S.S.); (D.Y.); (S.S.); (T.K.)
| | - Takanori Ohnishi
- Department of Neurosurgery, Washoukai Sadamoto Hospital, 1-6-1 Takehara, Matsuyama, Ehime 790-0052, Japan;
| | - Masahiro Nishikawa
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan; (M.N.); (H.W.); (K.K.); (Y.O.); (S.M.); (S.S.); (D.Y.); (S.S.); (T.K.)
| | - Hideaki Watanabe
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan; (M.N.); (H.W.); (K.K.); (Y.O.); (S.M.); (S.S.); (D.Y.); (S.S.); (T.K.)
| | - Kosuke Kusakabe
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan; (M.N.); (H.W.); (K.K.); (Y.O.); (S.M.); (S.S.); (D.Y.); (S.S.); (T.K.)
| | - Mashio Taniwaki
- Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime 791-0295, Japan; (M.T.); (R.K.)
| | - Hajime Yano
- Department of Molecular and Cellular Physiology, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan; (H.Y.); (J.T.)
| | - Yoshihiro Ohtsuka
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan; (M.N.); (H.W.); (K.K.); (Y.O.); (S.M.); (S.S.); (D.Y.); (S.S.); (T.K.)
| | - Shirabe Matsumoto
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan; (M.N.); (H.W.); (K.K.); (Y.O.); (S.M.); (S.S.); (D.Y.); (S.S.); (T.K.)
| | - Satoshi Suehiro
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan; (M.N.); (H.W.); (K.K.); (Y.O.); (S.M.); (S.S.); (D.Y.); (S.S.); (T.K.)
| | - Daisuke Yamashita
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan; (M.N.); (H.W.); (K.K.); (Y.O.); (S.M.); (S.S.); (D.Y.); (S.S.); (T.K.)
| | - Seiji Shigekawa
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan; (M.N.); (H.W.); (K.K.); (Y.O.); (S.M.); (S.S.); (D.Y.); (S.S.); (T.K.)
| | - Hisaaki Takahashi
- Division of Pathophysiology, Faculty of Pharmaceutical Sciences, Hokuriku University, Kanazawa, Ishikawa 920-1181, Japan;
| | - Riko Kitazawa
- Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime 791-0295, Japan; (M.T.); (R.K.)
| | - Junya Tanaka
- Department of Molecular and Cellular Physiology, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan; (H.Y.); (J.T.)
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan; (M.N.); (H.W.); (K.K.); (Y.O.); (S.M.); (S.S.); (D.Y.); (S.S.); (T.K.)
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Guberina N, Padeberg F, Pöttgen C, Guberina M, Lazaridis L, Jabbarli R, Deuschl C, Herrmann K, Blau T, Wrede KH, Keyvani K, Scheffler B, Hense J, Layer JP, Glas M, Sure U, Stuschke M. Location of Recurrences after Trimodality Treatment for Glioblastoma with Respect to the Delivered Radiation Dose Distribution and Its Influence on Prognosis. Cancers (Basel) 2023; 15:cancers15112982. [PMID: 37296942 DOI: 10.3390/cancers15112982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND While prognosis of glioblastoma after trimodality treatment is well examined, recurrence pattern with respect to the delivered dose distribution is less well described. Therefore, here we examine the gain of additional margins around the resection cavity and gross-residual-tumor. METHODS All recurrent glioblastomas initially treated with radiochemotherapy after neurosurgery were included. The percentage overlap of the recurrence with the gross tumor volume (GTV) expanded by varying margins (10 mm to 20 mm) and with the 95% and 90% isodose was measured. Competing-risks analysis was performed in dependence on recurrence pattern. RESULTS Expanding the margins from 10 mm to 15 mm, to 20 mm, to the 95%- and 90% isodose of the delivered dose distribution with a median margin of 27 mm did moderately increase the proportion of relative in-field recurrence volume from 64% to 68%, 70%, 88% and 88% (p < 0.0001). Overall survival of patients with in-and out-field recurrence was similar (p = 0.7053). The only prognostic factor significantly associated with out-field recurrence was multifocality of recurrence (p = 0.0037). Cumulative incidences of in-field recurrences at 24 months were 60%, 22% and 11% for recurrences located within a 10 mm margin, outside a 10 mm margin but within the 95% isodose, or outside the 95% isodose (p < 0.0001). Survival from recurrence was improved after complete resection (p = 0.0069). Integrating these data into a concurrent-risk model shows that extending margins beyond 10 mm has only small effects on survival hardly detectable by clinical trials. CONCLUSIONS Two-thirds of recurrences were observed within a 10 mm margin around the GTV. Smaller margins reduce normal brain radiation exposure allowing for more extensive salvage radiation therapy options in case of recurrence. Prospective trials using margins smaller than 20 mm around the GTV are warranted.
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Affiliation(s)
- Nika Guberina
- Department of Radiation Therapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Florian Padeberg
- Department of Radiation Therapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Christoph Pöttgen
- Department of Radiation Therapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Maja Guberina
- Department of Radiation Therapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Lazaros Lazaridis
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Tobias Blau
- Institute of Neuropathology, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery and Spine Surgery, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Kathy Keyvani
- Institute of Neuropathology, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Björn Scheffler
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
- DKFZ-Division Translational Neurooncology at the West German Cancer Center (WTZ), DKTK Partner Site, University Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Jörg Hense
- Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Julian P Layer
- Department of Radiation Oncology, University of Bonn, University Hospital Bonn, 53127 Bonn, Germany
- Institute of Experimental Oncology, University of Bonn, University Hospital Bonn, 53127 Bonn, Germany
| | - Martin Glas
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Martin Stuschke
- Department of Radiation Therapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
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Kantelhardt S. New Strategies in Diagnosis and Treatments for Brain Tumors. Cancers (Basel) 2023; 15:cancers15112879. [PMID: 37296841 DOI: 10.3390/cancers15112879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
In general, cancer is one of the most frequent causes of death [...].
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Affiliation(s)
- Sven Kantelhardt
- Department of Neurosurgery, Vivantes Hospital im Friedrichshain, Landsberger Allee 49, 10249 Berlin, Germany
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Glioblastoma and Methionine Addiction. Int J Mol Sci 2022; 23:ijms23137156. [PMID: 35806160 PMCID: PMC9266821 DOI: 10.3390/ijms23137156] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
Glioblastoma is a fatal brain tumor with a bleak prognosis. The use of chemotherapy, primarily the alkylating agent temozolomide, coupled with radiation and surgical resection, has provided some benefit. Despite this multipronged approach, average patient survival rarely extends beyond 18 months. Challenges to glioblastoma treatment include the identification of functional pharmacologic targets as well as identifying drugs that can cross the blood-brain barrier. To address these challenges, current research efforts are examining metabolic differences between normal and tumor cells that could be targeted. Among the metabolic differences examined to date, the apparent addiction to exogenous methionine by glioblastoma tumors is a critical factor that is not well understood and may serve as an effective therapeutic target. Others have proposed this property could be exploited by methionine dietary restriction or other approaches to reduce methionine availability. However, methionine links the tumor microenvironment with cell metabolism, epigenetic regulation, and even mitosis. Therefore methionine depletion could result in complex and potentially undesirable responses, such as aneuploidy and the aberrant expression of genes that drive tumor progression. If methionine manipulation is to be a therapeutic strategy for glioblastoma patients, it is essential that we enhance our understanding of the role of methionine in the tumor microenvironment.
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