Advances in optical technology are now changing how cancer is observed and treated. Researchers have developed a way to safely deliver chemotherapeutic agents inside cancer cells when triggered by a two-photon laser. This light-activated drug-delivery system, along with the use of specially designed glasses that allow clinicians to see cancer cells, are showing promise in early clinical applications.
At Washington University School of Medicine in St. Louis, MO, some surgeons are sporting new high-tech goggles that have the potential to help lower cancer morbidity by improving surgical techniques and thereby reducing the need for further surgeries. This wearable near-infrared (NIR) fluorescence goggle system is based on complementary metal-oxide semiconductor active pixel sensor imaging and uses see-through display technologies that guide surgery in real time.
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“I think the goggles are very promising and will help us, as surgeons, to identify the cancer better,” said Julie Margenthaler, MD, a breast surgeon and associate professor of surgery at Washington University. “The short-term goal is to lower morbidity from the repeat surgeries, but we hope it will help with mortality too.”
During a recent surgical procedure to remove breast cancer, Dr. Margenthaler used the head-mounted goggles, which uses custom video technology combined with with a targeted molecular agent that attaches to the cancer cells, making them glow blue. This allowed her to treat only the cancer, with the hopes that it resulted in much cleaner margins. Over the next 6 months, a total of 25 patients with breast cancer or melanoma will be participating in a clinical trial testing the effectiveness of these NIR goggles when treating cancer. Dr. Margenthaler said approximately 20% to 25% of patients with breast cancer who undergo a lumpectomy require a second surgery because current technology does not adequately show the extent of the disease during the initial operation.
“We hope these goggles can guide us so that when we leave the operating room, we know we had clear margins. They can also be used to monitor whether cancer cells have gone to the lymph nodes, and we hope to eventually be able to see metastasis elsewhere,” Dr. Marganthaler said in an interview with ChemotherapyAdvisor.com. “We have been working on this for about 8 years. We want it to be ergonomically useful…the goggles now are very light and they are not uncomfortable to wear. They are a little bit heavy, so you have to get use to it.”
In pilot study conducted in animal models, researchers at Washington University used indocyanine green, a commonly used contrast agent approved by the US Food and Drug Administration (FDA). The researchers found that the goggles were capable of detecting fluorescence of indocyanine green solution in the picomolar range, and with the help of NIR quantum dots, the goggles were successful in guiding sentinel lymph node mapping.1 In this study from Liu et al, published in the Journal of Biomedical Optics, the researchers demonstrated that tumors as small as 1 mm in diameter could be detected.
Dr. Margenthaler said preoperative imaging modalities such as CT scans and MRI have significant limitations. However, with this type of fluorescence imaging, it is possible to penetrate deeper into tissues than can typically be achieved with visible light imaging. Although she said more development and testing will need to be done, so far, she and her team are very encouraged by the potential benefits to patients with cancer, as these goggles may eliminate the need for follow-up surgery and the associated pain, inconvenience, and anxiety.
