Significant improvement in superselective intra-arterial chemotherapy for advanced paranasal sinus cancer by using indocyanine green fluorescence

Abstract

Recent advances in indocyanine green (ICG) fluorescence imaging have enabled the visualization of the blood supply to tissues. For advanced head and neck cancer, intra-arterial chemotherapy has been applied for improving the prognosis and organ preservation. To identify the tumor-feeding artery, CT angiography has been shown to be useful. However, the presence of dental metals sometimes disturbs the precise evaluation of paranasal sinus cancer patients by CT angiography. The objectives of the study were to assess the feasibility of the ICG fluorescence technique during intra-arterial chemotherapy for advanced maxillary cancer. Thirty-six patients with paranasal sinus cancer who were treated by intra-arterial chemotherapy were included. Conventional CT angiography followed by 5 mg of ICG injection was performed to confirm the areas in which the drug had dispersed. Intra-arterial chemotherapy was administered at 150 mg/m2 of CDDP four times weekly. Additional information about the arteries feeding the tumors provided by ICG was evaluated. Out of 36 cases, in 17 (47%) the blood supply to the cancer was clearly detected by CT angiography. By adding the infrared ICG evaluation, the blood supply to the tumor was confirmed easily in all cases without radiation exposure. The information obtained from fluorescence imaging was helpful for making decisions concerning the administration of chemo-agents for paranasal sinus cancers in cases involving dental metal, or skin invasion. ICG fluorescence imaging combined with intra-arterial chemotherapy compensated for the deficiencies of CT angiography for paranasal sinus cancer. ICG fluorescence provided us clearer and more useful information about the feeders to cancers.

Real-time surveillance of surgical margins via ICG-based near-infrared fluorescence imaging in patients with OSCC

“…The authors reported an ICG sensitivity of 100%. Other reports showed ICG positivity in 36 patients with advanced paranasal sinus cancer 19 . These results confirmed that ICG was an excellent molecular tracer for head and neck cancers, in addition to other solid tumors.…”

Feasibility of real‐time near‐infrared indocyanine green fluorescence endoscopy for the evaluation of mucosal head and neck lesions

“…This was helpful to confirm the target region for intra-arterial chemotherapy, especially in cases in which standard CT angiography was not indicative. 9 Recently, Digonnet et al 22 used NIR ICG imaging primarily to study the fluorescence of negative and negative lymph nodes during neck dissection in 11 patients. Five of these 11 patients also received a resection of the primary tumor.…”

“…In the head and neck area, it has been used so far casuistically only as ICG angiography for the monitoring of free flaps or for the evaluation of the relation of larger vessels to skull base tumors . It has been applied in paranasal tumors to adapt intra‐arterial chemotherapy . Recently, ICG has been introduced as a marker for sentinel node biopsies in patients with head and neck cancer .…”

“…7,8 It has been applied in paranasal tumors to adapt intra-arterial chemotherapy. 9 Recently, ICG has been introduced as a marker for sentinel node biopsies in patients with head and neck cancer. 10,11 If ICG NIR endoscopy could improve the visualization of the mucosal lesion itself, it has not been evaluated so far.…”

Current Trends and Emerging Future of Indocyanine Green Usage in Surgery and Oncology: An Update

“…A feeding vessel was identified in 100 % of 25 cases versus 56 % with CT. 91 In a similar study, Yokohama et al visualized a feeding vessel in 47 % of 36 cases of paranasal sinus cancer with CT versus 100 % with NIR fluorescence imaging. 92 Watanabe et al recommended ICG for preoperative colonic tattooing. It was cleaner than blue dye, had fewer side effects and histologic artifact, lasted up to 14 days, and was detected in 100 % of cases.…”