Page 191 - Fluorescence-guided cancer surgery

Imaging systems
Successful uorescence-guided surgery depends on the combination of both contrast agents and imaging systems. Therefore, the development of imaging systems is crucial for the wide acceptance of uorescence-guided surgery. Over the last years, multiple companies and institutes have launched imaging systems, all with their pros and cons9. Especially in endoscopic imaging there is much to gain, as suggested in chapter 4 and 5 of this thesis. Moreover, a more standardized approach to compare systems could assist in the development of new improved systems10.
Clinical implementation
To provide guidance in the clinical implementation of image-guided surgery, cooperation is necessary, and international society’s, like the International Society of Image Guided Surgery, are formed to discuss regulatory pathways and clinical trial design11;12. Endpoints in phase 1 studies should focus not only on safety, but also on imaging endpoints.
There is a promising role for the development of pharmacokinetic and pharmacodynamic models13-15. These models could give more insight in all the di erent variables that play a role in the mechanism of action in tumor imaging. Information on compound size, half-life, clearance, receptor density, tumor volume, binding constant, protein binding and so on could be combined in a model. Even imaging characteristics as quantum yield and wavelength can be added. This could potentially predict safety and imaging outcomes of newly designed compounds and could provide information on the optimal dose of a drug. The information obtained from these models could lead to exposure of less healthy subject and patients in rst in human studies. It could even predict which imaging system performs best for a speci c indication with a speci c compound. This would make phase 1 studies more e cient, and lower the hurdle for promising compounds to enter the clinic.
New clinical indications
Cancer treatment requires a multidisciplinary approach where surgery, systemic chemotherapy or immunotherapy and radiotherapy all play a signi cant role16;17. Recent developments in neoadjuvant chemo-radiation therapy have resulted in an increase in the number of complete pathological response in for example rectal and oesophageal cancer18-20. These patients won’t bene t
Summary and future perspectives 189