Fluorescence-guided cancer surgery : clinical translation of tumor-targeted agents

Intraoperative visualization of tumors could be enhanced by the use of near-infrared (nir) fluorescent contrast agents. The fluorescence imaging field first focused on clinically available contrast agents that do not specifically bind to tumor cells. Nowadays the focus is shifting more towards novel contrast agents that target receptors overexpressed on tumor cells. Part one of this thesis illustrates the road towards the use of tumor-targeted fluorescent agents, by highlighting the disadvantages of the use of non-targeted fluorescent contrast agents and demonstrating how to select biomarkers for tumor targeted fluorescence imaging. In part two of this thesis the clinical translation of tumor-targeted agents is exemplified by describing the introduction of three different agents for several indications (ovarian cancer, breast cancer and pancreatic cancer) in four clinical trials. Part three focusses on the future perspectives of image-guided fluorescence surgery. The road toward clinical application and implementation, associated challenges, and the possible actions to overcome them are summarized in this part.