Abstract
.Significance: Surgery is often paramount in the management of many solid organ malignancies because optimal resection is a major factor in disease-specific survival. Cancer surgery has multiple challenges including localizing small lesions, ensuring negative surgical margins around a tumor, adequately staging patients by discriminating positive lymph nodes, and identifying potential synchronous cancers. Intraoperative molecular imaging (IMI) is an emerging potential tool proposed to address these issues. IMI is the process of injecting patients with fluorescent-targeted contrast agents that highlight cancer cells prior to surgery. Over the last 5 to 7 years, enormous progress has been achieved in tracer development, near-infrared camera approvals, and clinical trials. Therefore, a second biennial conference was organized at the University of Pennsylvania to gather surgical oncologists, scientists, and experts to discuss new investigative findings in the field. Our review summarizes the discussions from the conference and highlights findings in various clinical and scientific trials.Aim: Recent advances in IMI were presented, and the importance of each clinical trial for surgical oncology was critically assessed. A major focus was to elaborate on the clinical endpoints that were being utilized in IMI trials to advance the respective surgical subspecialties.Approach: Principal investigators presenting at the Perelman School of Medicine Abramson Cancer Center’s second clinical trials update on IMI were selected to discuss their clinical trials and endpoints.Results: Multiple phase III, II, and I trials were discussed during the conference. Since the approval of 5-ALA for commercial use in neurosurgical malignancies, multiple tracers and devices have been developed to address common challenges faced by cancer surgeons across numerous specialties. Discussants also presented tracers that are being developed for delineation of normal anatomic structures that can serve as an adjunct during surgical procedures.Conclusions: IMI is increasingly being recognized as an improvement to standard oncologic surgical resections and will likely advance the art of cancer surgery in the coming years. The endpoints in each individual surgical subspecialty are varied depending on how IMI helps each specialty solve their clinical challenges.
Highlights
Malignant neoplasms account for the second leading cause of death worldwide and it is estimated that, by 2040, the incidence of such neoplasms will increase by almost 50%.1 Despite advances in noninvasive management of these diseases, surgery remains an integral part of curative treatment and will continue to be an important aspect of the management of solid tumors
IMI is increasingly being recognized as an improvement to standard oncologic surgical resections and will likely advance the art of cancer surgery in the coming years
Across the spectrum of cancers, complete resection (R0) of disease has been shown to reduce recurrence and increase disease-free survival (DFS).[2]. This surgical goal remains a challenge for oncologic surgeons across specialties because patients frequently present with synchronous or metachronous lesions not detected in preoperative radiographic evaluations, have large tumor burden, abut or invade critical structures in the vicinity, and have residual disease in the tumor bed due to inadequate surgical margins or localized skip metastases.[3]
Summary
Malignant neoplasms account for the second leading cause of death worldwide and it is estimated that, by 2040, the incidence of such neoplasms will increase by almost 50%.1 Despite advances in noninvasive management of these diseases, surgery remains an integral part of curative treatment and will continue to be an important aspect of the management of solid tumors. Across the spectrum of cancers, complete resection (R0) of disease has been shown to reduce recurrence and increase disease-free survival (DFS).[2]. This surgical goal remains a challenge for oncologic surgeons across specialties because patients frequently present with synchronous or metachronous lesions not detected in preoperative radiographic evaluations, have large tumor burden, abut or invade critical structures in the vicinity, and have residual disease in the tumor bed due to inadequate surgical margins or localized skip metastases.[3] Conventional means of obtaining a complete resection during surgery have relied on tactile and visual assessment intraoperatively by the surgeon. Additional challenges include adequate and appropriate staging of patients such as identifying lymph nodes containing micrometastatic disease, thereby altering the postoperative management of this subgroup of patients
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