Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Pathology, University of Miami, Miami, Florida.
Clin Cancer Res. 2024 Sep 13;30(18):4016-4028. doi: 10.1158/1078-0432.CCR-24-0940.
The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has continually increased during the past several decades. Using transoral robotic surgery (TORS) significantly improves functional outcomes relative to open surgery for OPSCC. However, TORS limits tactile feedback, which is often the most important element of cancer surgery. Fluorescence-guided surgery (FGS) strategies to aid surgeon assessment of malignancy for resection are in various phases of clinical research but exhibit the greatest potential impact for improving patient care when the surgeon receives limited tactile feedback, such as during TORS. Here, we assessed the feasibility of intraoperative fluorescence imaging using panitumumab-IRDye800CW (PAN800) during TORS in patients with OPSCC.
Twelve consecutive patients with OPSCC were enrolled as part of a nonrandomized, prospective, phase II FGS clinical trial using PAN800. TORS was performed with an integrated robot camera for surgeon assessment of fluorescence. Intraoperative and ex vivo fluorescence signals in tumors and normal tissue were quantified and correlated with histopathology.
Intraoperative robot fluorescence views delineated OPSCC from normal tissue throughout the TORS procedure (10.7 mean tumor-to-background ratio), including in tumors with low expression of the molecular target. Tumor-specific fluorescence was consistent with surgeon-defined tumor borders requiring resection. Intraoperative robot fluorescence imaging revealed an OPSCC fragment initially overlooked during TORS based on brightfield views, further substantiating the clinical benefit of this FGS approach.
The results from this patient with OPSCC cohort support further clinical assessment of FGS during TORS to aid resection of solid tumors.
在过去几十年中，口咽鳞状细胞癌（OPSCC）的发病率持续上升。与 OPSCC 的开放式手术相比，经口机器人手术（TORS）显著改善了功能预后。然而，TORS 限制了触觉反馈，而触觉反馈通常是癌症手术中最重要的元素。荧光引导手术（FGS）策略可帮助外科医生评估癌症切除的恶性程度，目前正处于临床研究的各个阶段，但当外科医生接收到有限的触觉反馈时（例如在 TORS 期间），FGS 策略具有最大的改善患者护理的潜力。在这里，我们评估了在 OPSCC 患者中使用 panitumumab-IRDye800CW（PAN800）进行 TORS 时术中荧光成像的可行性。
12 例 OPSCC 患者连续入组，作为使用 PAN800 的非随机、前瞻性、II 期 FGS 临床试验的一部分。TORS 手术使用集成的机器人摄像头进行，以便外科医生评估荧光。对肿瘤和正常组织中的术中荧光信号和离体荧光信号进行定量，并与组织病理学相关联。
术中机器人荧光视图在整个 TORS 手术过程中勾勒出 OPSCC 与正常组织的边界（平均肿瘤与背景比为 10.7），包括分子靶标低表达的肿瘤。肿瘤特异性荧光与外科医生定义的需要切除的肿瘤边界一致。术中机器人荧光成像显示，基于亮场视图，TORS 过程中最初被忽视的 OPSCC 片段，进一步证实了这种 FGS 方法的临床益处。
来自该 OPSCC 患者队列的结果支持进一步评估 FGS 在 TORS 中的应用，以辅助实体肿瘤的切除。
