Oncologic Procedures Amenable to Fluorescence-guided Surgery

Abstract

Objective: Although fluorescence imaging is being applied to a wide range of cancers, it remains unclear which disease populations will benefit greatest. Therefore, we review the potential of this technology to improve outcomes in surgical oncology with attention to the various surgical procedures while exploring trial endpoints that may be optimal for each tumor type. Background: For many tumors, primary treatment is surgical resection with negative margins, which corresponds to improved survival and a reduction in subsequent adjuvant therapies. Despite unfavorable effect on patient outcomes, margin positivity rate has not changed significantly over the years. Thus, patients often experience high rates of re-excision, radical resections, and overtreatment. However, fluorescence-guided surgery (FGS) has brought forth new light by allowing detection of subclinical disease not readily visible with the naked eye. Methods: We performed a systematic review of clinicatrials.gov using search terms ‘‘fluorescence,’’ ‘‘image-guided surgery,’’ and ‘‘near-infrared imaging’’ to identify trials utilizing FGS for those received on or before May 2016. Inclusion criteria: fluorescence surgery for tumor debulking, wide local excision, whole-organ resection, and peritoneal metastases. Exclusion criteria: fluorescence in situ hybridization, fluorescence imaging for lymph node mapping, nonmalignant lesions, nonsurgical purposes, or image guidance without fluorescence. Results: Initial search produced 844 entries, which was narrowed down to 68 trials. Review of literature and clinical trials identified 3 primary resection methods for utilizing FGS: (1) debulking, (2) wide local excision, and (3) whole organ excision. Conclusions: The use of FGS as a surgical guide enhancement has the potential to improve survival and quality of life outcomes for patients. And, as the number of clinical trials rise each year, it is apparent that FGS has great potential for a broad range of clinical applications.

Development and evaluation of a connective tissue phantom model for subsurface visualization of cancers requiring wide local excision

“…51 However, we were unsuccessful in dissecting the 2∶1 IBR condition without cutting into the inclusion. The reason for this is likely twofold: (1) as determined in the present study, the 1% blood and 1% intralipid condition has the highest observed fluorescence among the connective tissues, which would reduce contrast, and (2) the blinded surgeon did not have a predetermined target fluorescence value as a stopping criteria. In this study, we advanced our previous techniques using surgical testing phantoms to determine both the target fluorescence value that would allow a surgeon to achieve a 1-cm margin and by accounting for the effect of volume on observed fluorescence.…”

“…Numerous advances for surgical resection have been proposed, one of which is the use of fluorescence guidance to aid in identifying tumor boundaries and residual cancer cells. 1 Fluorescence-guided surgery (FGS) has proven particularly useful in cancers of the brain, 2-5 bladder, [6][7][8] and head and neck, 9,10 because these cancers are present on the organ surface, and can be viewed directly with administration of fluorescent probes combined with specially equipped surgical microscopes. However, many tumors lie below the surface of the organ and are, therefore, not currently amenable to direct fluorescence visualization.…”

Characterizing the detection threshold for optical imaging in surgical oncology

“…Utilization of a higher energy source emitter such as radioactivity may further decrease the disease detection threshold. However, IRDye800CW requires immediate sensitivity assessment due to its quick clinical integration …”

“…However, IR-Dye800CW requires immediate sensitivity assessment due to its quick clinical integration. 6,26 Employing a cetuximab-IRDye800CW dose that is 1.2% of a clinical dose is presumably sub-saturating. As a result, probe accumulation is decreased, which consequentially reduces detection capabilities.…”

Advanced Nanotechnology Leading the Way to Multimodal Imaging‐Guided Precision Surgical Therapy

“…[109][110][111][112][113] However, the clinical application of novel optical imaging techniques faces various challenges, as well as requirements for optimal nanoprobes, as follows: 1) deep tissue penetration and high brightness; 2) high SBR or T/NT ratio to recognize tumors correctly Adv. [109][110][111][112][113] However, the clinical application of novel optical imaging techniques faces various challenges, as well as requirements for optimal nanoprobes, as follows: 1) deep tissue penetration and high brightness; 2) high SBR or T/NT ratio to recognize tumors correctly Adv.…”