First Fluorescence-Guided Ovarian Cancer Surgery a Success

The surgery, performed at University Medical Center of Groningen (The Netherlands) was first in a group of ten scheduled procedures, forming part of the first phase of a clinical trial to evaluate the technology. The technique involves attaching a fluorescent imaging agent to a modified form of folic acid (folate), which acts as a "homing device" to seek out and attach itself to ovarian cancer cells, which over-express folate receptor-α (FR-α).

The patients are injected with the drug combination two hours prior to surgery; a multispectral fluorescence camera then illuminates the cancer cells and displays their location on a flat-screen monitor next to the patient during surgery. The surgical team reported finding an average of 34 tumor deposits using this technique, compared with an average of just seven tumor deposits using visual and tactile observations alone. The study was published early online on September 18, 2011, in Nature Medicine.

“This system is very easy to use and fits seamlessly in the way surgeons do open and laparoscopic surgery, which is the direction most surgeries are headed in the future,” said professor of surgery Gooitzen van Dam, MD, of the division of surgical oncology and the Bio-Optical Imaging Center at the University of Groningen. “I think this technology will revolutionize surgical vision. I foresee it becoming a new standard in cancer surgery in a very short time.”

“Ovarian cancer is notoriously difficult to see, and this technique allowed surgeons to spot a tumor 30 times smaller than the smallest they could detect using standard techniques,” added Professor of Chemistry Philip Low, PhD, of Purdue University, who invented the technology. “By dramatically improving the detection of the cancer - by literally lighting it up - cancer removal is dramatically improved.”

Folate can be used like a Trojan horse to sneak an imaging agent or drug into a cancer cell; and ovarian cancer has one of the highest rates of FR-α receptor expression, at about 85%. Around 80% of endometrial, lung, and kidney cancers, and 50% of breast and colon cancers also express the receptor. However, not all cancer cells do, and a test is necessary to determine if a specific patient's cancer expresses the receptor in large enough quantities for the technique to work.

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