Craig Sonya E L, Wright James, Sloan Andrew E, Brady-Kalnay Susann M
Department of Molecular Biology and Microbiology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
World Neurosurg. 2016 Jun;90:154-163. doi: 10.1016/j.wneu.2016.02.060. Epub 2016 Feb 23.
The median life expectancy after a diagnosis of glioblastoma is 15 months. Although chemotherapeutics may someday cure glioblastoma by killing the highly dispersive malignant cells, the most important contribution that clinicians can currently offer to improve survival is by maximizing the extent of resection and providing concurrent chemo-radiation, which has become standard. Strides have been made in this area with the advent and implementation of methods of improved intraoperative tumor visualization. One of these techniques, optical fluorescent imaging with targeted molecular imaging agents, allows the surgeon to view fluorescently labeled tumor tissue during surgery with the use of special microscopy, thereby highlighting where to resect and indicating when tumor-free margins have been obtained. This advantage is especially important at the difficult-to-observe margins where tumor cells infiltrate normal tissue. Targeted fluorescent agents also may be valuable for identifying tumor versus nontumor tissue. In this review, we briefly summarize nontargeted fluorescent tumor imaging agents before discussing several novel targeted fluorescent agents being developed for glioma imaging in the context of fluorescent-guided surgery or live molecular navigation. Many of these agents are currently undergoing preclinical testing. As the agents become available, however, it is necessary to understand the strengths and weaknesses of each.
胶质母细胞瘤确诊后的中位预期寿命为15个月。尽管化疗药物有朝一日可能通过杀死高度分散的恶性细胞治愈胶质母细胞瘤，但目前临床医生为提高生存率所能做出的最重要贡献是最大限度地扩大切除范围并进行同步放化疗，这已成为标准治疗方案。随着术中肿瘤可视化改善方法的出现和应用，该领域已取得进展。其中一项技术，即使用靶向分子成像剂的光学荧光成像，使外科医生在手术期间能够使用特殊显微镜观察荧光标记的肿瘤组织，从而突出显示切除部位并指示何时获得无肿瘤切缘。这一优势在肿瘤细胞浸润正常组织的难以观察的边缘部位尤为重要。靶向荧光剂对于识别肿瘤组织与非肿瘤组织也可能有价值。在本综述中，我们在讨论几种正在开发用于荧光引导手术或实时分子导航的胶质瘤成像的新型靶向荧光剂之前，简要总结非靶向荧光肿瘤成像剂。目前许多此类试剂正在进行临床前测试。然而，随着这些试剂的出现，有必要了解每种试剂的优缺点。
