Next Generation Sentinel Node Mapping

工程摘要 在头颈部原发性鳞状细胞癌患者中， 被认为是生存的最重要的负面预后因素。尽管先进的解剖学和 代谢成像技术，在临床和放射学分期为淋巴结阴性（cN 0）、隐匿性 淋巴结转移仍然存在于20-30%患者中。为了解决这个问题，目前的指导方针建议 选择性区域颈清扫术或前哨淋巴结活检。与颈淋巴清扫术相比，最低限度- 侵入性前哨淋巴结活检最大限度地减少了手术发病率、美容畸形和手术时间。 然而，前哨淋巴结活检技术在头颈部肿瘤中尚未得到广泛应用 因为肿瘤通常是不可接近的，并且患者对直接肿瘤注射耐受性差（目前 护理标准）。为了促进在常规临床实践中采用这种微创技术， 在美国，我们建议克服这些传统的障碍，前哨淋巴结活检使用 全身递送的药剂以代替局部注射的药剂。为此，我们建议进行一项先导研究， 和颈部癌症患者，以确定放射性或荧光标记的帕尼单抗的存在是否与 在手术获得的淋巴结切除术样本中有癌症的组织学证据。如果成功，我们的研究 这将是第一个评估全身显像剂用于前哨淋巴结活检的试验 识别和移除。这项技术在头颈部癌症中的成功应用可能会 对淋巴结状态起重要作用的其他肿瘤类型的影响。

Project Abstract In patients with primary squamous cell carcinoma of the head and neck, the presence of lymph node metastasis is considered the most important negative prognostic factor for survival. Despite advanced anatomic and metabolic imaging techniques, in patients staged clinically and radiographically as node-negative (cN0), occult lymph node metastasis are still present in 20-30% of patients. To address this, the current guidelines recommend either elective regional neck dissection or sentinel lymph node biopsy. Compared to a neck dissection, minimally- invasive sentinel lymph node biopsy minimizes surgical morbidity, cosmetic deformity, and duration of surgery. unfortunately, the sentinel lymph node biopsy technique has not been widely adopted in head and neck cancer because the tumors are often inaccessible and patients poorly tolerate direct tumor injections (the current standard of care). To facilitate the adoption of this minimally-invasive technique in routine clinical practice the United States, we propose to overcome these traditional barriers to sentinel lymph node biopsy using a systemically delivered agents to replace locally injected agents. To this end, we propose a pilot study in head and neck cancer patients to determine if the presence of radio- or fluorescence-labeled panitumumab correlates with histological evidence of cancer in surgically obtained lymphadenectomy samples. If successful, our study would be the first trial to evaluate the use of a systemic imaging agent for sentinel lymph node biopsy identification and removal. Successful application of this technique to head and neck cancers could have implications for other tumor types for which lymph node status plays an important role.