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The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer
Although surgical resection has been the primary treatment modality of solid tumors for decades, surgeons still rely on visual cues and palpation to delineate healthy from cancerous tissue. This may contribute to the high rate (up to 30%) of positive margins in head and neck cancer resections. Margi...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Society of Nuclear Medicine
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581234/ https://www.ncbi.nlm.nih.gov/pubmed/30733319 http://dx.doi.org/10.2967/jnumed.118.222810 |
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author | van Keulen, Stan Nishio, Naoki Fakurnejad, Shayan Birkeland, Andrew Martin, Brock A. Lu, Guolan Zhou, Quan Chirita, Stefania U. Forouzanfar, Tymour Colevas, A. Dimitrios van den Berg, Nynke S. Rosenthal, Eben L. |
author_facet | van Keulen, Stan Nishio, Naoki Fakurnejad, Shayan Birkeland, Andrew Martin, Brock A. Lu, Guolan Zhou, Quan Chirita, Stefania U. Forouzanfar, Tymour Colevas, A. Dimitrios van den Berg, Nynke S. Rosenthal, Eben L. |
author_sort | van Keulen, Stan |
collection | PubMed |
description | Although surgical resection has been the primary treatment modality of solid tumors for decades, surgeons still rely on visual cues and palpation to delineate healthy from cancerous tissue. This may contribute to the high rate (up to 30%) of positive margins in head and neck cancer resections. Margin status in these patients is the most important prognostic factor for overall survival. In addition, second primary lesions may be present at the time of surgery. Although often unnoticed by the medical team, these lesions can have significant survival ramifications. We hypothesize that real-time fluorescence imaging can enhance intraoperative decision making by aiding the surgeon in detecting close or positive margins and visualizing unanticipated regions of primary disease. The purpose of this study was to assess the clinical utility of real-time fluorescence imaging for intraoperative decision making. Methods: Head and neck cancer patients (n = 14) scheduled for curative resection were enrolled in a clinical trial evaluating panitumumab-IRDye800CW for surgical guidance (NCT02415881). Open-field fluorescence imaging was performed throughout the surgical procedure. The fluorescence signal was quantified as signal-to-background ratios to characterize the fluorescence contrast of regions of interest relative to background. Results: Fluorescence imaging was able to improve surgical decision making in 3 cases (21.4%): identification of a close margin (n = 1) and unanticipated regions of primary disease (n = 2). Conclusion: This study demonstrates the clinical applications of fluorescence imaging on intraoperative decision making. This information is required for designing phase III clinical trials using this technique. Furthermore, this study is the first to demonstrate this application for intraoperative decision making during resection of primary tumors. |
format | Online Article Text |
id | pubmed-6581234 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Society of Nuclear Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-65812342019-06-21 The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer van Keulen, Stan Nishio, Naoki Fakurnejad, Shayan Birkeland, Andrew Martin, Brock A. Lu, Guolan Zhou, Quan Chirita, Stefania U. Forouzanfar, Tymour Colevas, A. Dimitrios van den Berg, Nynke S. Rosenthal, Eben L. J Nucl Med Oncology Although surgical resection has been the primary treatment modality of solid tumors for decades, surgeons still rely on visual cues and palpation to delineate healthy from cancerous tissue. This may contribute to the high rate (up to 30%) of positive margins in head and neck cancer resections. Margin status in these patients is the most important prognostic factor for overall survival. In addition, second primary lesions may be present at the time of surgery. Although often unnoticed by the medical team, these lesions can have significant survival ramifications. We hypothesize that real-time fluorescence imaging can enhance intraoperative decision making by aiding the surgeon in detecting close or positive margins and visualizing unanticipated regions of primary disease. The purpose of this study was to assess the clinical utility of real-time fluorescence imaging for intraoperative decision making. Methods: Head and neck cancer patients (n = 14) scheduled for curative resection were enrolled in a clinical trial evaluating panitumumab-IRDye800CW for surgical guidance (NCT02415881). Open-field fluorescence imaging was performed throughout the surgical procedure. The fluorescence signal was quantified as signal-to-background ratios to characterize the fluorescence contrast of regions of interest relative to background. Results: Fluorescence imaging was able to improve surgical decision making in 3 cases (21.4%): identification of a close margin (n = 1) and unanticipated regions of primary disease (n = 2). Conclusion: This study demonstrates the clinical applications of fluorescence imaging on intraoperative decision making. This information is required for designing phase III clinical trials using this technique. Furthermore, this study is the first to demonstrate this application for intraoperative decision making during resection of primary tumors. Society of Nuclear Medicine 2019-06 /pmc/articles/PMC6581234/ /pubmed/30733319 http://dx.doi.org/10.2967/jnumed.118.222810 Text en © 2019 by the Society of Nuclear Medicine and Molecular Imaging. Immediate Open Access: Creative Commons Attribution 4.0 International License (CC BY) allows users to share and adapt with attribution, excluding materials credited to previous publications. License: https://creativecommons.org/licenses/by/4.0/. Details: http://jnm.snmjournals.org/site/misc/permission.xhtml. |
spellingShingle | Oncology van Keulen, Stan Nishio, Naoki Fakurnejad, Shayan Birkeland, Andrew Martin, Brock A. Lu, Guolan Zhou, Quan Chirita, Stefania U. Forouzanfar, Tymour Colevas, A. Dimitrios van den Berg, Nynke S. Rosenthal, Eben L. The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer |
title | The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer |
title_full | The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer |
title_fullStr | The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer |
title_full_unstemmed | The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer |
title_short | The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer |
title_sort | clinical application of fluorescence-guided surgery in head and neck cancer |
topic | Oncology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581234/ https://www.ncbi.nlm.nih.gov/pubmed/30733319 http://dx.doi.org/10.2967/jnumed.118.222810 |
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