The Clinical Value of Fluorescence Imaging in Head and Neck Cancer

English summary The main objective for curative oncologic surgery is to remove tumor tissue in conjunction with tumor-free margins. The essence for surgeons hereby lies in distinguishing healthy from diseased tissue to ensure satisfying prognosis. Today, surgeons make this important distinction based on tissue palpation and visual appearance, occasionally followed by frozen section analysis (FSA) – a technique that has substantial flaws, especially in complex surgery such as the head and neck. This might in part explain the high rates of tumor-positive margins and subsequent suboptimal overall survival rates afflicted with surgical head and neck oncology. The past decades, intraoperative imaging techniques utilizing near-infrared (NIR) fluorescence have been developed to aid surgeons in distinguishing tumor from healthy adjacent tissue. These real-time imaging techniques provide an essential step towards improving surgical outcome through enhanced tumor visualization and thereby increase patient survival. The first targeted fluorescent agents have been evaluated in multiple early phase trials and are now entering large scale clinical testing. It is now that we can start to monitor where the true clinical capacity of this technique lies. This thesis aims to lay a clinical foundation and explore the future possibilities of intraoperative fluorescence-guidance for surgical head and neck oncology. By providing an overview of various in situ and ex vivo imaging strategies, the work aims to illustrate the clinical possibilities and subsequently smoothen the transition of fluorescence imaging into today’s clinic.