The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer

• DOI: 10.2967/jnumed.118.222810
• Publication Date: 2019-02-07T22:37:56Z
• Authors: Stan van Keulen; Naoki Nishio; Shayan Fakurnejad; Andrew Birkeland; Brock A. Martin; Guolan Lu; Quan Zhou; Stefania U. Chirita; Tymour Forouzanfar; A. Dimitrios Colevas; Nynke S. van den ...; Eben L. Rosenthal
• Keywords: Image Processing; Clinical Trials and Supportive Activities; Clinical Sciences; 610; Bioengineering; Rare Diseases; Computer-Assisted; Clinical Research; Image Processing, Computer-Assisted; Humans; Dental/Oral and Craniofacial Disease; Cancer; screening and diagnosis; Optical Imaging; Evaluation of treatments and therapeutic interventions; real-time intraoperative imaging; 3. Good health; Detection; Nuclear Medicine & Medical Imaging; Oncology; Surgery, Computer-Assisted; Head and Neck Neoplasms; Biomedical Imaging; Surgery; head and neck cancer; Patient Safety; 6.4 Surgery; fluorescence-guided surgery; 4.2 Evaluation of markers and technologies

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.