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Fluorescence-guided surgery combined with intraoperative photodynamic therapy for recurrent atypical and anaplastic intracranial meningiomas: a prospective feasibility studyстатья
Информация о цитировании статьи получена из
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Статья опубликована в журнале из списка Web of Science и/или Scopus
Дата последнего поиска статьи во внешних источниках: 1 апреля 2026 г.
- Авторы: Nechaeva Anastasiia, Kukanov Konstantin, Ulitin Alexey, Olyushin Victor, Sitovskaya Daria, Bobkov Danila, Ushanov Vseslav, Combs Stephanie E., Samochernykh Konstantin, Shevtsov Maxim
- Журнал: Frontiers in oncology
- Том: 16
- Год издания: 2026
- Издательство: Frontiers Research Foundation
- Местоположение издательства: Switzerland
- Номер статьи: 1767269
- DOI: 10.3389/fonc.2026.1767269
- Аннотация: Objective: Recurrent intracranial meningiomas are a significant therapeuticchallenge due to their invasive growth and high recurrence risk after surgeryand radiotherapy. This study investigates the feasibility of a novel integratedapproach combining 5-aminolevulinic acid (5-ALA) fluorescence-guidedsurgery (FGS) with intraoperative photodynamic therapy (PDT) for recurrentatypical and anaplastic meningiomas.Methods: In a single-center, prospective cohort study, 23 patients with recurrentatypical and anaplastic meningiomas received the experimental treatmentprotocol (FGS+PDT). A retrospective control group (n=35) underwentconventional microsurgery. The intervention included preoperative 5-ALAadministration, FGS with visual (Fluorescence Intensity Score, FIS) andquantitative biospectroscopy (Fluorescence Index, FI) guidance, tumorresection, and subsequent PDT (635 nm laser) applied to the resection cavityand tumor matrix. Biospectroscopy guided PDT endpoint (photobleaching anddecreasing of FI). Primary outcomes included feasibility, safety, and extent ofresection (Simpson Grade), short follow-up period. Histopathological andimmunofluorescence analyses of paired pre-/post-PDT biopsies assessedbiological effects.Results: The FGS+PDT protocol was successfully completed in all patients with anexcellent safety profile; no adverse events were attributed to 5-ALA or PDT. Alltumors exhibited visible 5-ALA fluorescence. Gross-total resection (Simpson I-II)was achieved in 95.6% (22/23) of the study group versus 77.1% (27/35) in controls(p<0.05). Biospectroscopy revealed significant PpIX accumulation even in visuallylow-fluorescence tumors. Over a median follow-up of 16 months, no recurrenceswere observed in the experimental group. Histopathological analysisdemonstrated profound PDT-induced effects, including total ablation ofprogesterone receptor expression in the tumor matrix and a significant increasein caspase-3-mediated apoptosis in the peritumoral zone (36.3 ± 9.6 vs. 14.8 ±2.2 cells/mm², p<0.0001). Confocal microscopy confirmed subcellular damage,including mitochondr i a l dysfunction, nuclear degradation, andHsp70 overexpression.Conclusion: The integrated FGS and PDT protocol is feasible, safe, anddemonstrates compelling preliminary efficacy for recurrent atypical andanaplastic meningiomas. It enhances resection and induces profoundcytotoxic and apoptotic effects in the residual tumor bed and peritumoralzone. These results need to be further validated in larger, randomizedcontrolled trials.
- Добавил в систему: Куканов Константин Константинович