Leiden University Scholarly Publications

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Tummers, W.S.F.J. (2018)

Diagnostic and intraoperative targeted molecular imaging for pancreatic cancer

Doctoral Thesis
For years, pancreatic cancer had a dismal prognosis with a long term survival of around 5%. Since the centralization of pancreatic cancer surgery and the introduction of systemic chemotherapy with FOLFIRINOX, the median overall survival increased to around 20%. Radical tumor-margin free resection provides the patient with the best potential chance for cure. However, due to late onset of symptoms, the majority of patients present with inoperable disease. These patients can benefit from neoadjuvant therapy, or palliative chemotherapy. During clinical practice, this means that decision-making before and during surgery is critical to select the most optimal primary treatment modality. Currently, conventional imaging modalities lack sensitivity to detect small metastatic lesions, and are unable to visualize treatment response on neoadjuvant therapy. Tumor-specific molecular imaging in the form of fluorescence and photoacoustic imaging aids the surgeon to...Show moreFor years, pancreatic cancer had a dismal prognosis with a long term survival of around 5%. Since the centralization of pancreatic cancer surgery and the introduction of systemic chemotherapy with FOLFIRINOX, the median overall survival increased to around 20%. Radical tumor-margin free resection provides the patient with the best potential chance for cure. However, due to late onset of symptoms, the majority of patients present with inoperable disease. These patients can benefit from neoadjuvant therapy, or palliative chemotherapy. During clinical practice, this means that decision-making before and during surgery is critical to select the most optimal primary treatment modality. Currently, conventional imaging modalities lack sensitivity to detect small metastatic lesions, and are unable to visualize treatment response on neoadjuvant therapy. Tumor-specific molecular imaging in the form of fluorescence and photoacoustic imaging aids the surgeon to accurately recognize and resect malignant tissues in real-time during surgery. This thesis focuses on the challenges a surgeon faces during pancreatic cancer treatment, and the potential improvements that could be achieved by the use of tumor-specific imaging. In addition, the regulatory aspects of clinical translation of tumor-specific optical imaging agents are addressed.Show less
Tumor-specific imaging
Pancreatic cancer
Fluorescence imaging
Photoacoustics
Clinical translation
All authors
Tummers, W.S.F.J.
Supervisor
Velde, C.J.H. van de
Co-supervisor
Vahrmeier, A.L.; Swijnenburg, R.J.
Committee
Burggraaf, J.; Geus-Oei, L.F. de; Eijck, C.H.J. van; Gambhir, S.S.
Qualification
Doctor (dr.)
Awarding Institution
Faculty of Medicine, Leiden Uiversity Medical Center (LUMC), Leiden University
Date
2018-11-13
ISBN (print)
9789463324045

Funding

Sponsorship
Intuitive Surgical, Inc. LI-COR Biosciences, Surgvision, Quest Medical Imaging, LUMC, MSB Gouda, Chipsoft, Curadel, Groene Hart Ziekenhuis