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Utility of 5-ALA for fluorescence-guided resection of brain metastases: a systematic review

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Abstract

Purpose

5-aminolevulinic acid (5-ALA) has demonstrated its utility as an intraoperative imaging adjunct during fluorescence guided resection of malignant gliomas. However, literature regarding 5-ALA-guided resection for brain metastases is limited. We conducted a systematic review to evaluate the efficacy of 5-ALA fluorescence for resection of metastatic brain tumors.

Methods

PubMed was queried for studies involving 5-ALA and brain metastases, and results were screened following PRISMA guidelines. Articles related to 5-ALA and brain metastasis were further assessed based on inclusion and exclusion criteria and results were analyzed for 5-ALA fluorescence rates stratified by tumor primary sites and histological subtypes.

Results

Of 421 identified search results, 10 studies were included and a total of 631 patients analyzed. Of these studies, 60% were retrospective in design. The reported rates of 5-ALA fluorescence in included brain metastases ranged from 27.6 to 86.9%, with variability across and within tumor types. No studies concluded improved operative outcomes or survival outcomes related to 5-ALA use.

Conclusions

Current studies regarding 5-ALA fluorescence in brain metastases are limited and do not confirm efficacy for improving extent of resection or post-operative survival. Fluorescence is variable across and within tumor types. Further studies are necessary to evaluate whether specific tumors may benefit from 5-ALA FGS or if changes in delivery protocols or fluorescence quantification may affect intraoperative utility.

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Acknowledgements

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Funding

The authors declare that no financial support was received during the preparation of this manuscript.

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Author notes

  1. Harshal A. Shah and Sandra Leskinen have contributed equally.

Authors and Affiliations

  1. Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA

    Harshal A. Shah, Vinayak Narayan, Netanel Ben-Shalom & Randy S. D’Amico

  2. State University of New York Downstate Medical Center, Brooklyn, NY, USA

    Sandra Leskinen & Hamza Khilji

Authors
  1. Harshal A. Shah
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Contributions

All authors contributed to the study conception and design. Data collection, analysis, and the first draft were prepared by HS, SL, and HK. All authors commented on previous versions of the draft. All authors read and approved the final manuscript.

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Correspondence to Harshal A. Shah.

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Shah, H.A., Leskinen, S., Khilji, H. et al. Utility of 5-ALA for fluorescence-guided resection of brain metastases: a systematic review. J Neurooncol 160, 669–675 (2022). https://doi.org/10.1007/s11060-022-04188-0

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