Fluorescein-guided Resection of Brain Metastases Is a Protective Factor in Overall Survival: A Single Center, Retrospective Comparative Study

Introduction: Fluorescence-guided tumor resection, using agents such as fluorescein sodium (FS), can assist in achieving gross total resection (GTR, ≥ 95% resection), significantly improving prognosis. FS is routinely used for tumor resection at our institution. Here, we provide a comparison of resection rate and survival in patients undergoing solitary brain metastasis resection with or without FS.

Methods: This study was approved under our institutional review board. We identified all patients who underwent resection for brain metastasis from 2010 through 2022. FS was introduced to our institution in 2018. Prior to 2018, no intraoperative fluorescence was utilized. Patients with a solitary brain metastasis on standard preoperative MRI were stratified by intraoperative use of FS. GTR was based on the surgeon's report. A multivariate Cox hazard regression was used to compare overall survival for both cohorts.

Results: Fifty patients (25 with FS and 25 without FS) were included. No significant differences in sex, age, body mass index, smoking status, nor primary cancer were seen between groups. Metastases most commonly arose from primary lung cancer. GTR reported by surgeons did not significantly differ by group (84% non-FS versus 88% FS, p=1.00). However, survival analysis found FS-guided resection to be protective for overall survival (hazard ratio 0.06, 95% confidence interval [0.01, 0.53], p=0.012).

Conclusion : In this single center retrospective study, FS-guided resection was a protective factor for survival in patients with solitary brain metastases. FS is a low-cost fluorescence guidance tool with a limited side effect profile that may enhance survival in brain metastasis patients. However, prospective randomized controlled trials are necessary to confirm this finding.