Molecular fluorescence imaging facilitating clinical decision making in the treatment of solid cancers

In the last decades significant progress has been made in the treatment of patients with solid cancers. Progression in the multimodal treatments and the introduction of immunotherapy enabled the increase in treatment outcome and disease free survival of cancer patients. To increase the treatment outcomes for patients with solid tumors even further, an innovative technique is needed that contributes in the optimalisation of clinical decision making during diagnosis, monitoring of treatment responses and the selection of patients for the most optimal treatment strategy. Molecular fluorescence imaging is a technique that allows real-time visualisation of tumor tissue by tagging tumor specific proteins and biological processes that are involved in oncogenesis by making use of fluorescent tracers that binds to these proteins.

This thesis describes the potential of the clinical implementation of molecular fluorescence imaging to aid in clinical decision making before the start and during cancer treatments. During surgery, this technique can aid in the discrimination of tumor tissue from healthy tissue intra-operatively in patients with mammacarcinoma and colorectal carcinoma to optimise surgical resections or to prevent undertreatment and overtreatment. During endoscopy, molecular fluorescence endoscopy is applied in patients with rectal cancer to monitor treatment effects of neoadjuvant chemoradiotherapy to aid in more personalised treatment decisions in the future. The results in this thesis support further clinical translation of molecular fluorescence imaging that may lead to more personalised treatment of solid tumors, that might prevent under- and overtreatment of patients in the future and that might lead to an increase in disease free survival and an increase in the quality of life of cancer patients.