Brain and central nervous cancer presents a significant clinical burden, accounting for 2.4% of all cancer deaths. High grade glioma is particularly deadly, with 5 year survival times of 35% or less. Traditional treatment includes tumor resection followed by radiation therapy or chemotherapy. Aggressive resection is essential in order to prolong patient life. In fact, several studies have shown that life expectancy increases with increased extent of resection. Extent of resection is burdened by the fact that surgeons must be careful not to remove functional brain tissue. Resection is incomplete more often than not due to lack of visual cues for the surgeon. He must rely on tactile sensation to distinguish tumor from healthy tissue. Methods such as intraoperative MRI and CT exist, but these require expensive equipment and special training that is not available in all surgical environments. Some laboratories have proposed small molecule dyes to solve this problem, but these are insufficient when used in an invasive tumor model. It was the goal of this research to provide an objective cue in the form of a nanoencapsulated visible dye without the need for additional equipment of changes to the surgery process itself other than injection of the dye. We hypothesized that the nanocarrier would allow staining of the tumor through passive targeting by taking advantage of the enhanced permeability and retention effect. Once the nanocarriers have reached the desired target, they would not diffuse out into healthy tissue due to their large size compared to small molecule dyes, which readily diffuse out and stain healthy tissue. To test this hypothesis, we prepared and characterized a liposomal nanocarrier encapsulating Evans blue dye. The nanocarrier was tested for safety in vitro and in vivo, then used to delineate tumor margins in an invasive rat glioma model in vivo. Microscopic analysis was then conducted to ensure only tumor tissue was stained by the nanocarrier. This thesis presents a successful method of tumor border delineation to provide surgeons with positive visual cues without the need for changes in surgical environment or techniques.

Plattenepithelkarzinome der Kopf-Hals-Region sind durch einen aggressiven Krankheitsverlauf mit häufigem Auftreten von Lokalrezidiven und Zweitkarzinomen gekennzeichnet. Molekulare Veränderungen des Tumorrandes und der Tumor benachbarten Gewebe könnten in Ergänzung zur Histopathologie eine kurative chirurgische Tumorextirpation bestätigen. Wir untersuchten die Telomeraseaktivität in verschiedenen Entfernungen vom Tumorzentrum um ihre Verwendung als molekularen Marker zu prüfen. Wir untersuchten 80 kryokonservierte Gewebeschnitte von 40 Patienten mit einem Plattenepithelkarzinom im Kopf-Hals-Bereich, davon 33 karzinomfreie Tumorrandgewebe. 50% der 20 karzinomhaltigen Gewebe, 28 % der karzinomfreien Tumorrandgewebe und 35 % der tumorfernen Proben waren telomerasepositiv. Der Vergleich ergab keinen statistisch signifikanten Unterschied. Es konnte keine sichere Korrelation zwischen der Telomeraseaktivität in den untersuchten Geweben mit dem weiteren Krankheitsverlauf gefunden werden, allerdings zeigte die Telomerasepositivität in karzinomfreien Tumorrändern die Tendenz, mit einer besseren Prognose zu korrespondieren. Unsere Befunde sollten an einer größeren und homogeneren Patientengruppe überprüft werden. / Squamous cell carcinomas of the head-neck region are characterised by an aggressive course of disease and a strong tendency to loco-regional recurrence and second primary tumours. As a complement to histopathology, molecular changes of tumour marginal and tumor distant tissue may confirm curative surgical tumour extirpation. We tested telomerase activity at different distances to the tumour centre of squamous cell carcinomas to consider the use for molecular marker. We examined 80 cryo-conserved tissue samples from 40 patients with a squamous cell carcinoma of the head-neck region, among them 33 carcinoma-free margin tissues. 50 % of the carcinoma centres, 28 % of the carcinoma-free margin tissues and 35% of the tumour distant samples were telomerase-positive. The comparison showed no statistically significant difference. We have found no reliable correlation between telomerase activity in the carcinoma-free margin tissues and the further course of disease, but telomerase positivity in carcinoma-free tumour margins tended to correlate with a better prognosis. Confirmation of the results in a larger and more homogeneous patient group is needed.