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A brilliant innovation in brain tumor surgery: Fluorescent-guided resection

glowing brain tumorA fundamental tenet of all brain tumor surgery is for a surgeon to decide what is tumor — and what is normal brain tissue,” says neurosurgeon John Y.K. Lee, MD, MSCE. “In the OR, we rely on light to see what the tumor looks like; we use instruments to examine how it feels and pre-operative MRI data to make this critical assessment.” But even the most experienced surgeon can’t see cancer cells that are invisible to the human eye — occult cells that can cause a recurrence.

That was, until now.

Shedding new light on tumors

Always looking for new ways to expand tumor visualization in the OR, Dr. Lee enrolled brain tumor patients in a large Penn-generated research study based on the work of Sunil Singhal, MD, Director Center for Precision Surgery, Thoracic Surgery. The research study enrolled patients with solid tumors of the breast, lung and brain, and used a dye – indocyanine green (ICG) — and near infrared light in an experimental, yet innovative, way.

Dr. Lee explains, “The day before surgery, brain tumor patients who were enrolled in this clinical trial were injected with ICG. In the OR, under the fluorescent light in near infrared range of 800 nanometers — versus the usual 400 to 700 nanometer surgical light range — the tumors lit up like neon signs.”

More surgical data, more precise surgery

In brain surgery, we need to know precisely where the tumor’s margins lie. The investigational technique used in the clinical trials thus far has provided a far more detailed and nuanced picture of the surgical field and the tumor. Another benefit demonstrated during surgery is that the longer wave length of the near infrared light allowed us to actually see through tissue — in the brain, that is up to one centimeter through the brain itself and sometimes even through the covering of the brain - dura,” explains Dr. Lee.

A new “Glowing Tumor” study: Enrolling now for brain tumor patients

Dr. Lee is currently enrolling patients with all forms of brain tumors — glioblastoma, glioma, meningioma and brain metastases from lung and breast cancer —
into clinical trials deploying this technique.

While this is still considered an investigational technique currently under clinical trial, with the great successes seen to date, Penn’s hope is that its use during surgery will provide patients with the maximal safe surgical resection — and that its use after FDA review and approval will rapidly become a standard of care when surgically resecting cancers. If approved by the FDA, the goal of this technology is to more accurately stage the severity of the patient’s cancer and reduce the recurrence rate after surgery.

For information about enrolling a brain tumor patient in the clinical trial, contact Dr. Lee at 215-829-6700

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