Near-infrared fluorescence imaging in colorectal cancer and its metastases

Abstract

This thesis explores the clinical potential of near-infrared (NIR) fluorescence-guided surgery, particularly in colorectal cancer. It evaluates both non-targeted agents, such as indocyanine green (ICG), and targeted agents like SGM-101, an anti-CEA fluorescent antibody. NIR imaging shows promise for detecting tumors, assessing bowel perfusion, and improving outcomes in colorectal surgery. While early results suggest improved surgical decision-making and potential reductions in complications like anastomotic leakage, challenges remain, especially in standardizing signal interpretation and overcoming technical hurdles. Targeted imaging with SGM-101 proved effective in liver metastases, but less so in lung metastases, likely due to limitations in minimally invasive imaging systems. Nevertheless, real-time fluorescence imaging using SGM-101 demonstrated accurate tumor detection and correlation with CEACAM5 expression, supporting its further clinical evaluation. The thesis also introduces a data-driven approach for identifying new imaging targets in non-small cell lung cancer, identifying several promising biomarkers. This method may accelerate the development of novel fluorescent agents. In conclusion, NIR fluorescence-guided surgery offers substantial promise for enhancing surgical precision and patient outcomes. However, widespread clinical adoption depends on resolving technical limitations, validating new biomarkers, and demonstrating clear patient benefit through large-scale, controlled trials.