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Indocyanine Green (ICG) Guided Tumor Resection

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St. Jude Children's Research Hospital

キーワード

概要

This is a study to assess the ability of Indocyanine Green (ICG) to identify neoplastic disease. For many pediatric solid tumors, complete resection of the primary site and/or metastatic deposits is critical for achieving a cure. An optimal intra-operative tool to help visualize tumor and its margins would be of benefit. ICG real-time fluorescence imaging is a technique being used increasingly in adults for this purpose. We propose to use it during surgery for pediatric malignancies. All patients with tumors that require localization for resection or biopsy of the tumor and/or metastatic lesions will be eligible.
Primary Objective
To assess the feasibility of Indocyanine Green (ICG)-mediated near-infrared (NIR) imagery to identify neoplastic disease during the conduct of surgery to resect neoplastic lesions in children and adolescents. NIR imaging will be done at the start of surgery to assess NIR-positivity of the lesion(s) and at the end of surgery to assess completeness of resection. Separate assessments will be made for the following different histologic categories:
1. Osteosarcoma
2. Ewing Sarcoma
3. Rhabdomyosarcoma (RMS)
4. Non-Rhabdomyosarcoma Soft Tissue Sarcoma (NRSTS)
5. Neuroblastoma
6. Renal tumors
7. Metastatic pulmonary deposits
8. Liver tumors, lymphoma, other rare tumors, and nodules of unknown etiology
Exploratory Objectives
1. To compare the ICG uptake by primary vs metastatic site and pre-treated (chemotherapy, radiation, or both) vs non-pre-treated.
2. Assess the sensitivity and specificity of NIR imagery to find additional lesions not identified by standard of care intraoperative inspection and tactile feedback.
3. Assess the sensitivity and specificity of NIR imagery to find additional lesions not identified on preoperative diagnostic imaging.
4. Assess the sensitivity and specificity of NIR imagery for identifying residual disease at the conclusion of a tumor resection.

説明

This trial is a single center open-label study. Patients with a solid tumor or lymphoma who require resection either for therapeutic or diagnostic intent will be included.

Indocyanine Green (ICG) is an FDA-approved drug. The day before the surgery, patients will receive a single dose of ICG intravenously. Surgery will be performed the following day.

During surgery, after the surgeon identifies the mass through visual (seen with the naked eye) and or tactile methods (palpated), the patient will have his/her tumor field imaged by Iridium system optimized for detection of ICG (Visionsense Corp, Philadelphia, PA). The entire procedure will be photo- documented and recorded.

The Visionsense system records images in real time, calculates percentages, and captures the data. At least three different areas of the tumor will be measured. If the tumor cannot be identified by visual inspection or palpation, NIR-imaging will be used in an attempt to locate the lesion. The surrounding area will be inspected and measured to screen for additional sites of metastatic disease. After tumor resection, residual fluorescence in the surgical resection bed will be measured.

Direct subject participation in the trial will last for the period of time from injection of the ICG the day before surgery and until 24 hours post-surgery.

日付

最終確認済み: 03/31/2020
最初に提出された: 09/03/2019
提出された推定登録数: 09/08/2019
最初の投稿: 09/09/2019
最終更新が送信されました: 04/26/2020
最終更新日: 04/27/2020
実際の研究開始日: 02/06/2020
一次完了予定日: 12/30/2022
研究完了予定日: 12/30/2022

状態または病気

Neoplastic Disease
Solid Tumor

介入/治療

Drug: Indocyanine green (ICG)

段階

段階 1

アームグループ

介入/治療
Experimental: Indocyanine green (ICG)
Participants will receive a single dose of 1.5 mg/kg of ICG intravenously over 15 minutes the day before surgery.
Drug: Indocyanine green (ICG)
IV

適格基準

研究に適格な性別All
健康なボランティアを受け入れるはい
基準

Inclusion Criteria:

- Patients with a primary or relapsed solid tumor or lymphoma who require excision of the tumor or metastatic lesions.

Exclusion Criteria:

- Subjects with a history of iodide allergies, including positive allergic reaction to the screening iodine test.

- Inability or unwillingness of research participant or legal guardian/representative to give written informed consent.

- Patients with benign pathology.

- Patients with brain tumors.

- Pregnant female.

結果

主な結果の測定

1. Sensitivity and specificity rates of the ICG guided neoplastic disease identification [up to 24 hours post-surgery]

The 312 patients (39 patients in each of the 8 categories) will be evaluated for this objective.

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