Complete surgical removal of lesions improves survival of
peritoneal carcinomatosis and can be enhanced by intraoperative near-infrared fluorescence imaging.
Indocyanine green (ICG) is the only near-infrared
fluorescent dye approved for clinical use, but it lacks specificity for
tumor cells, highlighting the need for
tumor-selective targeting agents. We compared the
tumor-specific near-infrared
fluorescent probes Bevacizumab-
IRDye 800CW and Angiostamp800, which target
tumor angiogenesis and
cancer cells, to ICG for fluorescence-guided surgery in
peritoneal carcinomatosis of ovarian origin. The probes were administered to mice with orthotopic
peritoneal carcinomatosis prior to conventional and fluorescence-guided surgery. The influence of
neoadjuvant chemotherapy was also assessed. Conventional surgery removed 88.0 ± 1.2% of the total
tumor load in mice. Fluorescence-guided surgery allowed the resection of additional nodules, enhancing the total
tumor burden resection by 9.8 ± 0.7%, 8.5 ± 0.8%, and 3.9 ± 1.2% with Angiostamp800,
Bevacizumab-
IRDye 800CW and ICG, respectively. Interestingly, among the resected nodules, 15% were false-positive with ICG, compared to only 1.4% with Angiostamp800 and 3.5% with
Bevacizumab-
IRDye 800CW. Furthermore, conventional surgery removed only 69.0 ± 3.9% of the total
tumor burden after
neoadjuvant chemotherapy. Fluorescence-guided surgery with Angiostamp800 and
Bevacizumab-
IRDye 800CW increased the total
tumor burden resection to 88.7 ± 4.3%, whereas ICG did not improve surgery at all.
Bevacizumab-
IRDye 800CW and Angiostamp800 better detect ovarian
tumors and
metastases than the clinically used fluorescent tracer ICG, and can help surgeons completely remove
tumors, especially after surgery
neoadjuvant chemotherapy.