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Fluorescence-guided surgery combined with intraoperative photodynamic therapy for recurrent atypical and anaplastic intracranial meningiomas: a prospective feasibility study

Title: Fluorescence-guided surgery combined with intraoperative photodynamic therapy for recurrent atypical and anaplastic intracranial meningiomas: a prospective feasibility study
Authors: Nechaeva, Anastasiia; Kukanov, Konstantin; Ulitin, Alexey; Olyushin, Victor; Sitovskaya, Daria; Bobkov, Danila; Ushanov, Vseslav; Combs, Stephanie E.; Samochernykh, Konstantin; Shevtsov, Maxim
Contributors: Deutsche Forschungsgemeinschaft
Source: Frontiers in Oncology ; volume 16 ; ISSN 2234-943X
Publisher Information: Frontiers Media SA
Publication Year: 2026
Collection: Frontiers (Publisher - via CrossRef)
Description: Objective Recurrent intracranial meningiomas are a significant therapeutic challenge due to their invasive growth and high recurrence risk after surgery and radiotherapy. This study investigates the feasibility of a novel integrated approach combining 5-aminolevulinic acid (5-ALA) fluorescence-guided surgery (FGS) with intraoperative photodynamic therapy (PDT) for recurrent atypical and anaplastic meningiomas. Methods In a single-center, prospective cohort study, 23 patients with recurrent atypical and anaplastic meningiomas received the experimental treatment protocol (FGS+PDT). A retrospective control group (n=35) underwent conventional microsurgery. The intervention included preoperative 5-ALA administration, FGS with visual (Fluorescence Intensity Score, FIS) and quantitative biospectroscopy (Fluorescence Index, FI) guidance, tumor resection, and subsequent PDT (635 nm laser) applied to the resection cavity and tumor matrix. Biospectroscopy guided PDT endpoint (photobleaching and decreasing of FI). Primary outcomes included feasibility, safety, and extent of resection (Simpson Grade), short follow-up period. Histopathological and immunofluorescence analyses of paired pre-/post-PDT biopsies assessed biological effects. Results The FGS+PDT protocol was successfully completed in all patients with an excellent safety profile; no adverse events were attributed to 5-ALA or PDT. All tumors 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
Document Type: article in journal/newspaper
Language: unknown
DOI: 10.3389/fonc.2026.1767269
DOI: 10.3389/fonc.2026.1767269/full
Availability: https://doi.org/10.3389/fonc.2026.1767269; https://www.frontiersin.org/articles/10.3389/fonc.2026.1767269/full
Rights: https://creativecommons.org/licenses/by/4.0/
Accession Number: edsbas.62097AAC
Database: BASE