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荧光染料点亮癌细胞使手术更加有效

健康 89xy 3个月前 (11-24) 23次浏览

A tumor-specific fluorescent dye and an ultra-sensitive camera system used during surgery can help surgeons identify difficult-to-spot cancers. Surgeons at the University Medical Center, Groningen, the Netherlands, have used this technique for the first time on women with ovarian cancer. This type of cancer is typically difficult to detect early on, and is usually diagnosed at a late stage when prognosis is poor.

When a surgeon is operating on a cancer, he/she should ideally get it right during the first operation. However, tumors may be extremely small and hard to detect. With this new technology, which was created by a Purdue University researcher, the cancer cells literally glow, revealing themselves, so the surgeon can see what needs to be removed.

The surgery, reported in the journal Nature Medicine
, was the first of 10 performed during the first phase of a clinical trial which is assessing the technology. The technology aids surgeons when removing malignant tissue from ovarian cancer patients. Smaller tumors that could easily be missed are lit up, making it easier for the surgeon to spot them and remove them.

Philip Low, from Purdue University, who invented the technology, said surgeons are now able to clearly see clusters of cancer cells just one-tenth of a millimeter wide, compared to the previous 3 millimeters without the technology.

Low said:

“众所周知,卵巢癌很难发现,这种技术使外科医生能够发现比标准技术检测到的最小肿瘤小30倍的肿瘤。通过显著提高癌症的检出率——通过点亮它——癌症的清除率得到显著提高。”

荧光染料点亮癌细胞使手术更加有效

外科医生对有无肿瘤靶向荧光显像剂的卵巢癌细胞的看法。(图片由Gooitzen van Dam提供)[/ h/]

在这项技术中,一种荧光显像剂附着在一种经修饰的叶酸上;这就像一个寻的装置
搜寻卵巢癌细胞并附着于其上。病人在手术前两小时接受注射。多光谱荧光照相机照亮癌细胞,在外科手术过程中,在靠近病人的监视器上显示它们的确切位置。

外科医生通常希望使用视觉和触觉观察来发现大约七个肿瘤沉积物。用这种技术形成了34个肿瘤沉积。参与试验的外科医生古伊岑·范·达姆(Gooitzen van Dam)说,这项技术非常符合当前的外科手术实践。

Gooitzen van Dam说:

“这个系统非常容易使用,并且无缝地适合外科医生进行开放式和腹腔镜手术的方式,这是大多数手术未来的方向。我认为这项技术将彻底改变外科手术的视野。我预见它将在很短的时间内成为癌症手术的新标准。”

Low added that chemotherapy or immunotherapy is much more effective when less cancerous tissue remains behind after surgery.

Low said:

“对于卵巢癌来说,很明显,你可以切除的癌症越多,患者的预后就越好,”他说。“这就是为什么我们选择从卵巢癌开始。这似乎是开始改变人们生活的最佳场所。”

By concentrating on the removal of cancerous tissue, instead of evaluating patient outcome, the researchers were able to considerably reduce how long the clinical trial would take to complete.

Low said:

“我们真正追求的是患者获得更好的结果,但如果我们设计临床试验来评估荧光引导手术对预期寿命的影响,我们将不得不跟踪患者多年。相反,通过评估我们是否可以借助荧光成像来识别和去除更多的恶性组织,我们可以在手术后两小时内量化这种新方法的影响。我们希望这能让这项技术在更短的时间内被批准用于一般用途。”

Arrangements are underway with the Mayo Clinic for the next phase of the clinical studies.

Low had found that folate can be used like a Trojan horse to surreptitiously introduce an imaging agent or medication into a cancer cell. For ovarian cancer cells to grow and divide, they need large amounts of the vitamin (folic acid). Special receptors on the surface of the cancer cells seize the vitamin, and whatever is attached to it, and pull it inside.

As not all cancer cells express the folate receptor, a test is required to find out whether a patient’s cancer expresses enough of the receptors for the technique to be effective.

At about 85%, ovarian cancer has a very high rate of folate receptor expression. Expression rates for endometrial, kidney and lung cancers are at about 80%, and breast and colon cancers 50%.

Low and team are also looking into how they can target molecules that may be used to carry attached drugs or imaging agents to types of cancer that have no folate receptors.

He plans to develop a red fluorescent dye that can show up through the skin and deep inside the body. He now uses a green dye that has already been approved for patient usage. However, this green dye is not ideal for seeking out cancer cells deep in tissue. Green light has a short wavelength that does not pass through tissue very well, while red has longer a wavelength and does.

Low said:

“我们希望能够看到组织的更深处,而不是表面。不同的癌症有不同特征的肿瘤,一些分支并缠绕到更深的组织中。我们将继续发展这项技术,并做出有助于癌症患者的改进。”

Written by Christian Nordqvist


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