Preventing graft-versus-host disease: transplanters glimpse hope beyond immunosuppressants.

“Part of this is due to the fact that brain tumors have such poor prognosis in general, and any tools to help improve the resection can have immediate short-term benefit on patients’ lives. . . . A substantial benefit for brain tumor patients will probably come in improved systems to track weak fluorescence signals in areas not well resected using current systems, and in tumor subtypes that do not present well with ALA-PpIX fluorescence or vascular marking fluorescence such as fluorescein or indocyanine green.” Liu said that the combination of the distinctive contrasting agent and the microscopic device sets his group’s research apart. “It’s very important to use the two together,” said Liu. “There are a lot of contrast agents being developed, and there are other types of imaging devices. We took those two worlds and brought them together, showing that by using advanced microscopy technique, you can see the tumor cells and differentiate them from the normal cells with the use of this contrast agent.” The Stony Brook researchers believe that the combination of intraoperative confocal microscopy with molecularly targeted contrast agents could complement current image-guided surgery approaches, such as those with magnetic resonance imaging or computed tomography, to surgically remove brain tumors and other forms of cancer. Nader Sanai, M.D., director of the Division of Neurosurgical Oncology and Barrow Brain Tumor Research Center at St. Joseph’s Hospital in Phoenix, said he believes that the study is an important advance. “I think it is a clever way of using the tumor’s molecular biology to tell you where you are at with respect to the margins of the tumor. Plus, your naked eye is only going to tell you so much.” Sanai said that although microscopes are already in the operating room, they offer only magnification, not cellular resolution. “This device,” he said, “in combination with intelligently selected probes, gives you an entirely different dimension of understanding of what you’re looking at, where the tumor cells are, and how much you’ve actually done in removing them.” Friedman has a mixed reaction to the research and this study in particular. “Most of the studies published so far do suggest that the completeness of the resection is enhanced by using this technique,” Friedman said. “So that’s the good news. The bad news is that the fluorescence is only on the surface, meaning it’s limited. You can’t see anything that’s going on under the surface, since the light doesn’t penetrate more than a couple of millimeters. This means that no matter how good your resection is, you’re never going to completely cure these tumors with surgery.”