WP 2.10: Near-infrared fluorescence for assessing margins in musculoskeletal soft-tissue sarcoma surgery – repurposing established technology for novel applications

Sarcomas are rare and aggressive tumors. The management of sarcomas in orthopedic oncology is challenging, discerning tumor from healthy tissue intraoperatively difficult, and positive margin rates following primary surgery are high despite highly specialized treatment. Positive margins have been shown to be associated with increased local recurrence but the role of positive margins as an independent risk factor in survival is less clear. Fluorescence-guided surgery is a well-established technology that has been used in other surgical specialties for tumor identification, but also mapping of the lymphatic system and angiography. The technique involves injecting a dye that fluoresces which can then be detected intraoperatively through an imaging system. This project aims to assess whether fluorescence-guided surgery can be repurposed to improve intraoperative attainment of negative margins in soft-tissue sarcoma surgery in a national multicenter randomized controlled trial using indocyanine green – a fluorescent dye that has been shown to accumulate in sarcomas – and near-infrared imaging. To our knowledge, no randomized controlled trial exploring this modality has been performed. Additionally, we aim to assess the role of positive margins on local recurrence and survival through a retrospective cohort study based on the national Danish Sarcoma Registry.
If margins of sarcomas could be accurately determined intraoperatively through fluorescence-guided surgery, this would immediately reduce reoperations based on positive margins, most likely reduce local recurrence and may improve survival while sparing as much healthy tissue as possible.

Awarded to: Tine Engberg Damsgaard (Rigshospitalet) – CFA2

Awarded grant to support VIP personnel.