Indo-cyanine Green (ICG) in Paediatric Oncology MIS
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|ClinicalTrials.gov Identifier: NCT04854018|
Recruitment Status : Not yet recruiting
First Posted : April 22, 2021
Last Update Posted : April 22, 2021
Indo-cyanine green (ICG) is a dye that has been used for a variety of adult and paediatric uses since 1956. Over the past few years, near infrared (NIRF) technology has been developed which allow is use as a fluorescence agent during surgery. It has been used increasingly in the field of adult oncology surgery and has been shown to increase the efficacy of this surgery.
The aim of this study is to evaluate the use of NIRF and ICG during specific minimally invasive surgery (MIS) procedures within paediatric oncology surgery. Their use will complement existing surgical techniques rather than replace them.
Given the published advantages in adults this study aims to provide evidence of feasibility in the paediatric patients with cancer.
|Condition or disease||Intervention/treatment||Phase|
|Pediatric Renal Tumor Metastatic Osteosarcoma Metastatic Ewing Sarcoma Pulmonary Metastasis Rhabdomyosarcoma Non-Rhabdo. Soft Tissue Sarcoma||Drug: Indocyanine green||Phase 4|
The purpose of this study is to show the feasibility of using ICG in combination with NIRF and MIS in paediatric oncology surgery. It has been used increasingly over the past few years for a range of adult oncology surgical indications including tumour margin identification, lymph node identification and pulmonary metastectomy. It will be investigated in three groups of patients in our study:
- Tumour margin identification-Identifying the margins of a tumour intra-operatively is crucial for many paediatric cancers. Incomplete resections or resections with involved margins often require upstaging of treatment with more intensive chemotherapy or radiotherapy. ICG will be injected intravenously and then NIRF will be used intermittently until fluorescence is achieved and an evaluation of the tumour and its margins will be performed.
- Lymph node identification - It is standard of care for most oncology resections to remove lymph nodes that are suspected to be involved with tumour. Both SIOP and COG recommend the removal of 7 or more lymph nodes during a nephrectomy for Wilm's tumour although this is often not achieved. IGC will be injected directly into the tumour (or the adjacent tissue in 2-4 places) and then NIRF will be used intermittently until fluorescence is achieved. An evaluation of the tumour and any fluorescent lymph nodes will then take place and any fluorescent lymph nodes will be removed.
- Pulmonary metastectomy - Many paediatric cancers including Wilm's tumour have a propensity to metastasise to the lungs. Removal of all lung metastases is important as it has the potential to down-stage tumours, obviating the need for pulmonary radiotherapy.
Modern radiology techniques can identify lesions as small as 1mm which are often not palpable at the time of surgery. Relying on finger palpation requires patients to have a thoracotomy with all of the associated complications. ICG will be injected intravenously and then NIRF will be combined with MIS to identify any fluorescent lesions. The location of any lesions will be compared with those seen on pre-surgical imaging (current standard practice).
For all three groups of patients, the use of ICG and NIRF will complement rather than replace existing surgical technique in patients who require surgery already. Data will be collected on the number of lesions which do/do not fluoresce as well as the histology of lesions removed. They will be separated into lesions which do not fluoresce, lesions which were removed before fluorescence (they will be checked for ex-vivo fluorescence) and fluorescing lesions so that the histological characteristics of each group can be compared.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||15 participants|
|Intervention Model:||Single Group Assignment|
|Intervention Model Description:||open label, single centre, single arm, prospective feasibility study|
|Masking:||None (Open Label)|
|Official Title:||An Open Label, Single Centre, Single Arm, Prospective Feasibility Study Evaluating the Effectiveness of Near-infrared Fluorescence (NIRF) Using Indo-cyanine Green (ICG) in Minimally Invasive Paediatric Oncology Surgery (MIS)|
|Estimated Study Start Date :||April 30, 2021|
|Estimated Primary Completion Date :||September 2022|
|Estimated Study Completion Date :||September 2022|
Experimental: Single Arm
Injection of Indocyanine Green at doses detailed on summary of product characteristics for each age range
Drug: Indocyanine green
Intravenous or intraparenchymal injection
- Number of fluorescent nodes resected during minimally invasive tumour nephrectomy [ Time Frame: Until the end of surgery, 2 hours ]Number of fluorescent nodes resected per patient
- Is Fluorescent guided tumour resection easier than non-fluorescent guided. [ Time Frame: until the end of surgery, 2 hours ]Subjective surgeon analysis of intra-operative conditions on a Likert scale per patient
- To evaluate if NIRF and ICG allow detection of pulmonary metastases [ Time Frame: until the end of surgery, 2 hours ]Comparison of number of lesions seen on CT with those seen with fluoroscopy per patient
- To evaluate if fluorescent nodes or metastases are more likely to contain viable tumour [ Time Frame: until histopathology is reported, 2 weeks ]Number of fluorescent nodes and metastases containing viable tumour per patient
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04854018
|Contact: Max Pachl, MB,ChB,FRCSemail@example.com|
|Principal Investigator:||Max Pachl||Birmingham Women's and Children's NHS Foundation Trust|