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Standard of care in the management of cancer of the oral tongue is complete extirpation with clear margins. There is a direct correlation between the radial margin distance and local failure and death from disease.
Surgical resection of this site is balanced between resection of enough tissue to ensure clear margins and excessive resection that would result in unnecessary oral dysfunction. The optimal margin distance is 5 mm on permanent fixed histological assessment
Mucosal margins are obtained primarily using visual inspection with a reasonable degree of accuracy. More difficult is the deep margin which cannot be seen during the resection, where surgeons must rely on manual palpation to estimate the depth invasion and the needed deep margin tissue thickness.
Over the last three years we have utilized intraoperative ultrasound to improve the likelihood of a clear deep margin. Preliminary analysis has shown that using this technique we are able to reliably clear the deep margin with an improved rate of local control.
Drawing upon our preliminary findings using intraoperative ultrasound for surgical navigation, we have designed a study to employ dual functional antibody conjugates as a theranostic tool to allow molecular based optical imaging of tumor margins, improving precision of the resection and utilizing a benzoporphyrin derivative to provide for a tumor specific photodynamic therapy treatment at the time of resection.
Techniques and preliminary oncologic and margin outcomes of intraoperative ultrasound as well as the concepts of the use of dual functional antibody conjugates in surgical navigation will be discussed.
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Mark Varvares, Meredith August, Tayyaba Hasan, Srivalleesha Mallidi, "Surgical navigation in oral tongue cancer resections (Conference Presentation)," Proc. SPIE 11070, 17th International Photodynamic Association World Congress, 110703W (14 August 2019); https://doi.org/10.1117/12.2528072