Using Molecular Imaging to Identify Microscopic Residual Sarcoma Cells During Surgery
Local therapy for many soft tissue sarcomas includes limb-sparing surgery and radiation therapy. Randomized trials have established that for the majority of patients, local control can be achieved with surgery alone. However, in the absence of adjuvant radiation therapy, up to one-third of patients will suffer a local recurrence. Therefore, most sarcoma patients receive radiation therapy with its potentially severe side effects, but derive no clinical benefit. In order to personalize the delivery of radiation therapy to sarcoma patients that may benefit from this treatment, it will be necessary to identify sarcoma patients with microscopic residual sarcoma cells after surgery. To that end, I have led a team of engineers at MIT to develop technology that can detect microscopic residual sarcoma cells within a surgical bed. With funding from a Damon Runyon Rachleff Innovation Award, we have built a novel, wide-field of view imaging device with single sarcoma cell resolution. When combined with a molecular imaging probe, we have used this device to image primary soft tissue sarcomas in mice. Not only can the device detect microscopic residual sarcoma cells that lead to a local recurrence, but this approach successfully identifies mice with no residual sarcoma cells in the tumor bed that remain tumor-free after surgery. With an Advanced Clinical Research Award in Sarcoma, I will be able to bring this technology from the lab bench into the operating room. This award will give me the protected research time and the access to the clinical trial infrastructure necessary to complete a phase I/II study to test this technology in patients with soft tissue sarcomas. This clinical trial will establish the safety of the molecular imaging probe and determine if the imaging device can identify microscopic residual sarcoma cells in patients at the time of surgery.