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Kholaki O, Saxe BJ, Teigen K, Williams FC, Schlieve T, Kim RY. Does the use of a "wrap" in three-dimensional surgical planning influence the bony margin status of benign and malignant neoplasms of the oral, head, and neck region? An initial investigation. Oral Maxillofac Surg 2024; 28:163-167. [PMID: 36239829 DOI: 10.1007/s10006-022-01123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/09/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Three-dimensional surgical planning (3-DSP) is becoming commonplace in the management of benign and malignant disease for oral and maxillofacial surgery practice within the last decade. Surgeons utilize a virtual "wrap" to preoperatively delineate and define maxillofacial tumor resection margins. The investigators hypothesized that the use of a wrap is a predictable method to obtain negative bony margins. METHODS The investigators implemented a retrospective chart review. The sample was composed of patients over the age of 18 treated at John Peter Smith Health Network and Parkland/UT Southwestern Medical Center who obtained 3-DSP for the pathology of the head and neck, involving the bone, with a virtual wrap utilized for bony margins. The proportion of cases was calculated, descriptive statistics were reported, and binomial exact calculation was performed for confidence intervals. The primary variable analyzed was bony margin status on final histopathology, involved or uninvolved, based on the pathology report. RESULTS The sample was composed of 39 cases, one of which was excluded due to aborting the preplanned 3-DSP. Of the 38 included cases, one had involved bony margin on final histopathology (2.6%; 95% confidence limits, 0.1%, 13.8%). There were 16 malignant cases (42%) and 22 benign cases (58%). When stratified by pathology, 1 out of the 16 malignant cases (6.3%; 95% confidence interval, 0.2%, 30%) and 0 out of the 22 benign cases (95% confidence interval, 0%, 15.4%) had an involved bony margin on final histopathology. CONCLUSION The results of this preliminary study suggest three-dimensional surgical planning with wrap margins is a predictable method to obtain negative bony margins in benign and malignant disease of the maxillofacial complex. Further studies will focus on compiling prospective data to solidify the accuracy and predictability of using a wrap to obtain negative bony margins.
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Affiliation(s)
- Omar Kholaki
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Parkland/UT Southwestern Medical Center, Dallas, TX, USA
| | - Brandon J Saxe
- Division of Oral and Maxillofacial Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Kari Teigen
- Office of Clinical Research, John Peter Smith Health Network, Fort Worth, TX, USA
| | - Fayette C Williams
- Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, Fort Worth, TX, USA
| | - Thomas Schlieve
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Parkland/UT Southwestern Medical Center, Dallas, TX, USA
| | - Roderick Y Kim
- Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, Fort Worth, TX, USA.
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Byrd BK, Wells WA, Strawbridge RR, Barth CW, Samkoe KS, Gibbs SL, Davis SC. Evaluating Receptor-Specific Fresh Specimen Staining for Tumor Margin Detection in Clinical Breast Specimens. Mol Imaging Biol 2023; 25:911-922. [PMID: 37351769 PMCID: PMC10598096 DOI: 10.1007/s11307-022-01771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/22/2022] [Accepted: 09/06/2022] [Indexed: 06/24/2023]
Abstract
PURPOSE Reliable and rapid identification of tumor in the margins of breast specimens during breast-conserving surgery to reduce repeat surgery rates is an active area of investigation. Dual-stain difference imaging (DDSI) is one of many approaches under evaluation for this application. This technique aims to topically apply fluorescent stain pairs (one targeted to a receptor-of-interest and the other a spectrally distinct isotype), image both stains, and compute a normalized difference image between the two channels. Prior evaluation and optimization in a variety of preclinical models produced encouraging diagnostic performance. Herein, we report on a pilot clinical study which evaluated HER2-targeted DDSI on 11 human breast specimens. PROCEDURES Gross sections from 11 freshly excised mastectomy specimens were processed using a HER2-receptor-targeted DDSI protocol shortly after resection. After staining with the dual-probe protocol, specimens were imaged on a fluorescence scanner, followed by tissue fixation for hematoxylin and eosin and anti-HER2 immunohistochemical staining. Receiver operator characteristic curves and area under the curve (AUC) analysis were used to assess diagnostic performance of the resulting images. Performance values were also compared to expression level determined from IHC staining. RESULTS Eight of the 11 specimens presented with distinguishable invasive ductal carcinoma and/or were not affected by an imaging artifact. In these specimens, the DDSI technique provided an AUC = 0.90 ± 0.07 for tumor-to-adipose tissue and 0.81 ± 0.15 for tumor-to-glandular tissue, which was significantly higher than AUC values recovered from images of the targeted probe alone. DDSI values and diagnostic performance did not correlate with HER2 expression level, and tumors with low HER2 expression often produced high AUC, suggesting that even the low expression levels were enough to help distinguish tumor. CONCLUSIONS The results from this preliminary study of rapid receptor-specific staining in human specimens were consistent with prior preclinical results and demonstrated promising diagnostic potential.
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Affiliation(s)
- Brook K Byrd
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Wendy A Wells
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
| | | | - Connor W Barth
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR, 97201, USA
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Summer L Gibbs
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR, 97201, USA
| | - Scott C Davis
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.
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Akheel M, Senthilmurugan M, Sherlin HJ, Jain A, Chahwala Q, Wadhwania A. Association of Surgical Margins and Pathological Staging with Epidermal Growth Factor Receptor Expression in Oral Squamous Cell Carcinoma- A Prospective Cohort Study. Indian J Otolaryngol Head Neck Surg 2022; 74:6001-6006. [PMID: 36742945 PMCID: PMC9895264 DOI: 10.1007/s12070-021-02629-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/10/2021] [Indexed: 02/07/2023] Open
Abstract
Oral squamous cell carcinoma (SCC) is one among the most frequent cancers across the globe. The postoperative overall survival (OS) has not improved over years much despite of advanced surgical techniques and various anticancer drugs. A better and good understanding of molecular mechanisms and identification of potential oncogenes in OSCC may provide new therapeutic decisions such as target therapy in management of these cancer patients. To find whether there is any association between surgical margins and pathological staging with epidermal growth factor receptor expression affecting the prognosis in oral squamous cell carcinomas. A prospective cohort study was performed in 25 patients with biopsy proven oral squamous cell carcinoma who presented to our hospital from July 2017 to June 2019. The data collected from their report were pTNM staging, surgical margins (anterior, posterior, superior and inferior) and scoring of EGFR expression. Surgical margins with EGFR expression was found to have p-value of 0.023 and pTNM staging with EGFR expression was found to have p-value of 0.051 which were statistically significant. This study concludes that there is strong association of EGFR expression with pTNM and surgical margins which may influence the prognosis of the patient. This study helps us to understand the need of adding EGFR targets like cetuximab along with radiation instead of conventional cisplatin therapy.
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Affiliation(s)
- Mohammad Akheel
- Ph.D. Scholar, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu India
| | - M. Senthilmurugan
- Dept of Oral Oncology, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu India
| | - Herald J. Sherlin
- Dept of Pathology, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu India
| | - Amit Jain
- SRJ-CBCC Cancer Centre, Indore, India
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Algadi HH, Abou-Bakr AA, Jamali OM, Fathy LM. Toluidine blue versus frozen section for assessment of mucosal tumor margins in oral squamous cell carcinoma. BMC Cancer 2020; 20:1147. [PMID: 33238944 DOI: 10.1186/s12885-020-07644-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When the resected specimen is sent for intraoperative margin assessment, all margins are grossly checked, and selected margins undergo a frozen section (FS) examination. Therefore, there is a possibility of sampling error. This study evaluated the effectiveness of using toluidine blue (TB) as an intraoperative triage screening tool to detect positive mucosal margins of the resected specimens of oral squamous cell carcinoma (OSCC) and serve as a guide for FS sampling. METHODS Surgical samples of 30 consecutive patients with biopsy-proven OSCC were included in the study. A total of 140 mucosal margins were analyzed intraoperatively by TB and FS, the results were compared with the final histopathology. RESULTS Of the 140 examined mucosal tumor margins, 14 stained positives with TB, six were true-positives, eight were false-positives, and there were no false-negatives, as confirmed by final histopathology of the same margins. The diagnostic performance measures were sensitivity 100.0%; specificity 94.0%; positive predictive value (PPV) 42.9%; negative predictive value (NPV) 100.0%; and accuracy 94.3% (95% CI: 89.0-97.5%). For FS, there were three true-positives, three false-negatives, and no false-positives. The diagnostic performance measures were sensitivity 50.0%; specificity 100.0%; PPV 100.0%; NPV 97.8%; and accuracy 97.9% (95% CI: 93.9-99.6%). CONCLUSION TB is less specific but more sensitive than FS for detecting positive mucosal margins of resected OSCC. Screening the tumor mucosal margins with TB before FS sampling may help identify more tumor-bearing margins. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov. Registration number: NCT03554967 . Registration date: June 13, 2018.
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Cortese S, Kerrien E, Yakavets I, Meilender R, Mastronicola R, Renard S, Leroux A, Bezdetnaya L, Dolivet G. ICG-induced NIR fluorescence mapping in patients with head & neck tumors after the previous radiotherapy. Photodiagnosis Photodyn Ther 2020; 31:101838. [PMID: 32479902 DOI: 10.1016/j.pdpdt.2020.101838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/11/2020] [Accepted: 05/22/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The distinction between tumor and healthy tissues is complicated in the areas previously subjected to radiation therapy (RT). This is related to the fact that tissues can undergo delayed and irreversible deterioration such as inflammation, vascular alteration and fibrosis. The trials related to the fluorescence -guided surgery (FSG) in Head and Neck Squamous Cell Carcinoma (HNSCC) patients, previously subjected to RT, have not yet been reported. The present study addresses for the first time the possibilities of tumor near-infrared (NIR) imaging using Indocynaine Green (ICG) in irradiated areas. METHODS Four patients with histologically confirmed HNSCC were included in this study. All included patients were previously treated with RT with at least 50 Gy. RT-radiation fields from original treatment fully encompassed the second tumor or recurrence. ICG was injected via cephalic vein 45 min before the images were captured using a NIR camera system Artemis. The images were also captured before ICG injection serving as background signal. The fluorescence intensity measurements were carried out using specially designed software. RESULTS ICG fluorescence clearly demonstrated a significant difference in fluorescence intensity between healthy and tumor tissues in 2 of 4 patients. Histology post-resection analysis confirmed a complete tumor resection with safe surgical margins. No difference between tumor and surrounding healthy tissue was detected in patients with an epidermoid carcinoma developed from sclerohypertrophic lichen. CONCLUSIONS In our pilot study, we clearly established the feasibility of using NIR FGS with ICG to delineate tumor and healthy tissues in irradiated areas in infiltrating lichen-free tumors.
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Affiliation(s)
- Sophie Cortese
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France
| | - Erwan Kerrien
- Inria, Université de Lorraine, Loria, UMR7503, Vandœuvre-lès-Nancy, France
| | - Ilya Yakavets
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France; CRAN, CNRS, UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Rokia Meilender
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France
| | - Romina Mastronicola
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France; CRAN, CNRS, UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Sophie Renard
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France
| | - Agnes Leroux
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France; CRAN, CNRS, UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Lina Bezdetnaya
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France; CRAN, CNRS, UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Gilles Dolivet
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France; CRAN, CNRS, UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France.
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Abstract
PURPOSE OF REVIEW Surgical management of locally advanced oral cavity squamous cell carcinomas (OCSCC) has long been recognized as a primary treatment modality. Technological advances have led to significant improvements in our surgical approach, from improvement in the visualization of tumors to more efficient and precise reconstruction. Here, we review the latest technological advances in surgical extirpation and reconstruction of locally advanced OCSCCs. RECENT FINDINGS The focus of technological innovation in surgical extirpation has been on improving visualization, with the use of intraoperative ultrasound for margin delineation, intraoperative navigation, narrow-band imaging, and the use of fluorescence. Though early, these are promising steps to ensuring complete resection of the cancer. Advances in reconstruction have been centered on the incorporation of computer assisted design, manufacturing, and virtual surgical planning, allowing for more complex three-dimensional defects to be expeditiously reconstructed. As these technologies are still under development, their impact on oncologic outcomes are not yet robustly defined; however, as technology continues to advance and become more widely available, new technologies will undoubtedly become integrated into enhancing surgical precision and planning.
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Affiliation(s)
- Christopher M K L Yao
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1445, Houston, TX, 77030, USA.
| | - Edward I Chang
- Department of Plastic Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1258, Houston, TX, 77030, USA.
| | - Stephen Y Lai
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1445, Houston, TX, 77030, USA.
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Kauffmann EF, Napoli N, Menonna F, Iacopi S, Lombardo C, Bernardini J, Amorese G, Cacciato Insilla A, Funel N, Campani D, Cappelli C, Caramella D, Boggi U. A propensity score-matched analysis of robotic versus open pancreatoduodenectomy for pancreatic cancer based on margin status. Surg Endosc 2019; 33:234-242. [PMID: 29943061 DOI: 10.1007/s00464-018-6301-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND No study has shown the oncologic non-inferiority of robotic pancreatoduodenectomy (RPD) versus open pancreatoduodenectomy (OPD) for pancreatic cancer (PC). METHODS This is a single institution propensity score matched study comparing RPD and ODP for resectable PC, based on factors predictive of R1 resection (≤ 1 mm). Only patients operated on after completion of the learning curve in both procedures and for whom circumferential margins were assessed according to the Leeds pathology protocol were included. The primary study endpoint was the rate of R1 resection. Secondary study endpoints were as follows: number of examined lymph nodes (N), rate of perioperative transfusions, percentage of patients receiving adjuvant therapies, occurrence of local recurrence, overall survival, disease-free survival, and sample size calculation for randomized controlled trials (RCT). RESULTS Factors associated with R1 resection were tumor diameter, number of positive N, N ratio, logarithm odds of positive N, and duodenal infiltration. The matching process identified 20 RPDs and 24 OPDs. All RPDs were completed robotically. R1 resection was identified in 11 RPDs (55.0%) and in 10 OPDs (41.7%) (p = 0.38). There was no difference in the rate of R1 at each margin as well as in the proportion of patients with multiple R1 margins. RPD and OPD were also equivalent with respect to all secondary study endpoints, with a trend towards lower rate of blood transfusions in RPD. Based on the figures presented herein, a non-inferiority RCT comparing RPD and OPD having the rate of R1 resection as the primary study endpoint requires 3355 pairs. CONCLUSIONS RPD and OPD achieved the same rate of R1 resections in resectable PC. RPD was also non-inferior to OPD with respect to all secondary study endpoints. Because of the high number of patients required to run a RCT, further assessment of RPD for PC would require the implementation of an international registry.
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Affiliation(s)
| | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Francesca Menonna
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Sara Iacopi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Carlo Lombardo
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Juri Bernardini
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Gabriella Amorese
- Division of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | | | - Niccola Funel
- Division of Pathology, University of Pisa, Pisa, Italy
| | | | | | | | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. .,Azienda Ospedaliera Universitaria Pisana, Università di Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Zrnc TA, Wallner J, Zemann W, Pau M, Gstettner C, Brcic L, Assaf AT, Hassanzadeh H, Feichtinger M, Schwenzer-Zimmerer K. Assessment of tumor margins in head and neck cancer using a 3D-navigation system based on PET/CT image-fusion - A pilot study. J Craniomaxillofac Surg 2018. [PMID: 29526413 DOI: 10.1016/j.jcms.2018.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Determination of tumor margins in patients with squamous cell carcinoma of the head and neck (SCCHN) is mostly based on preoperative magnetic resonance imaging (MRI) or computed tomography scans (CT). Local recurrence of disease is often correlated with the presence of positive resection margins after surgical treatment. Positron emission tomography/computed tomography (PET/CT) imaging plays a crucial role in the assessment of patients with SCCHN. The purpose of this study was to determine whether PET/CT could predict tumor extension. METHODS In 12 patients who underwent surgical treatment of primary SCCHN (Stage III-IV) F18-FDG PET/CT image-fusion was performed on a 3D navigation-system based workstation. Image-guided needle biopsies were obtained from four different, color-coded metabolic areas within the tumor. The histopathological findings were correlated with findings on corresponding PET/CT scans. RESULTS 81.3% of biopsies from the central area were positive. Specimens taken from the outer metabolic zone were positive in 66.7% of the patients. The highest incidence of positive biopsies was found in the zone adjacent to the outermost area. There was a statistically significant difference in positive tumor histopathology when comparing the various metabolic zones (p = 0.03). CONCLUSION Exact determination of tumor is an important research topic, although results remain controversial. The results of this study suggest that in some cases PET scans may overestimate tumor extension.
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Affiliation(s)
- Tomislav A Zrnc
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria.
| | - Jürgen Wallner
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Wolfgang Zemann
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Mauro Pau
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Christian Gstettner
- Department of Radiology and Division of Nuclear Medicine, Medical University of Graz, Auenbruggerplatz 9, A-8036, Graz, Austria
| | - Luka Brcic
- Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, A-8036, Graz, Austria
| | - Alexandre T Assaf
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Matthias Feichtinger
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Katja Schwenzer-Zimmerer
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
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Hosseini A, Baker JL, Tokin CA, Qin Z, Hall DJ, Stupak DG, Hayashi T, Wallace AM, Vera DR. Fluorescent-tilmanocept for tumor margin analysis in the mouse model. J Surg Res 2014; 190:528-34. [PMID: 24923630 DOI: 10.1016/j.jss.2014.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/22/2014] [Accepted: 05/02/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Dendritic cells (DC) are localized in close proximity to cancer cells in many well-known tumors, and thus maybe a useful target for tumor margin assessment. MATERIALS AND METHODS [(99m)Tc]- cyanine 7 (Cy7)-tilmanocept was synthesized and in vitro binding assays to bone marrow-derived DC were performed. Fifteen mice, implanted with either 4T1 mouse mammary or K1735 mouse melanoma tumors, were administered 1.0 nmol of [(99m)Tc]-Cy7-tilmanocept via tail vein injection. After fluorescence imaging 1 or 2 h after injection, the tumor, muscle, and blood were assayed for radioactivity to calculate percent-injected dose. Digital images of the tumors after immunohistochemical staining for DC were analyzed to determine DC density. RESULTS In vitro binding demonstrated subnanomolar affinity of [(99m)Tc]-Cy7-tilmanocept to DC (KA = 0.31 ± 0.11 nM). After administration of [(99m)Tc]-Cy7-tilmanocept, fluorescence imaging showed a 5.5-fold increase in tumor signal as compared with preinjection images and a 3.3-fold difference in fluorescence activity when comparing the tumor with the surgical bed after tumor excision. Immunohistochemical staining analysis demonstrated that DC density positively correlated with tumor percent of injected dose per gram (r = 0.672, P = 0.03), and higher DC density was observed at the periphery versus center of the tumor (186 ± 54 K versus 64 ± 16 K arbitrary units, P = 0.001). CONCLUSIONS [(99m)Tc]-Cy7-tilmanocept exhibits in vitro and in vivo tumor-specific binding to DC and maybe useful as a tumor margin targeting agent.
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Livi L, Meattini I, Franceschini D, Saieva C, Meacci F, Marrazzo L, Gerlain E, Desideri I, Scotti V, Nori J, Sanchez LJ, Orzalesi L, Bonomo P, Greto D, Bianchi S, Biti G. Radiotherapy boost dose-escalation for invasive breast cancer after breast-conserving surgery: 2093 patients treated with a prospective margin-directed policy. Radiother Oncol 2013; 108:273-8. [PMID: 23490271 DOI: 10.1016/j.radonc.2013.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 02/16/2013] [Accepted: 02/17/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the outcome of invasive early breast cancer patients that underwent breast-conserving surgery and adjuvant radiotherapy (RT), treated with a prospective margin-directed institutional policy for RT boost dose, based on final margins status (FMS). METHODS AND MATERIALS A total of 2093 patients were treated between 2000 and 2008. 10 Gy boost was prescribed in case of FMS>5mm; 16 Gy boost with FMS between 2 and 5mm; 20 Gy boost in case of FMS<2mm or positive. RESULTS After a median follow up of 5.2 years, we recorded 41 local relapse (LR, 2%). Concerning LR free survival, age at diagnosis, nuclear grade, hormonal status, T-stage, adjuvant hormonal therapy and adjuvant chemotherapy emerged as significant parameters (p-values from log rank test <0.05). FMS, that directed the RT boost dose, did not have significant impact on LRFS (p=0.46). LR rates were 2.3% for FMS<2mm, 2.6% for 2-5mm FMS and 1.8% for FMS>5mm. At multivariate analysis, higher nuclear grade (p=0.045), triple negative subtype (p=0.036) and higher T-stage (p=0.02) resulted as the independent predictors of LR occurrence. CONCLUSIONS Our experience showed that a margin-directed policy of RT boost dose-escalation seems to reduce the negative impact of FMS on LR, but it is not able to overcome the unfavorable effect of higher nuclear grade, higher T stage and triple negative subtype.
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Affiliation(s)
- Lorenzo Livi
- Radiotherapy Unit, University of Florence, Italy
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