Charles L Hitchcock1*, Thomas J Magliery2, Cathy Mojzisik3, Morgan Johnson4, Mark W Arnold5 and Edward W Martin5
1Department of Pathology, Ohio State University, 1645 Neil Ave Columbus, OH 43210, USA
2Department of Chemistry & Biochemistry, Ohio State University, Columbus, OH 43210 100W 18th Ave, USA
3Clinical Development, Enlyton Ltd. 1216 Kinnear Rd Columbus, OH 43212, USA
4Department of Medicine, Ohio State University College of Medicine, 370 W 9th Ave Columbus, OH 43210, USA
5Department of Surgery, Ohio State University, 410 W 10th Ave Columbus, OH 43210, USA
Current surgical procedures for colorectal adenocarcinoma are plagued by a lack of precise information provided by preoperative imaging and the surgeon’s exploration of the surgical field using traditional techniques (i.e., inspection and palpation). The staging of colorectal adenocarcinoma begins with preoperative imaging and ends with the pathologist; however, potential sources of error between these two points may result in suboptimal treatment impacting outcome. Using colorectal adenocarcinoma as a model, we developed a System incorporating currently available technologies to increase the precision of tumor imaging before and during surgery as well as intraoperative tumor detection. The multimodal System focused on the patient evolved over 35 years. The System brings together essential resources (i.e., molecular probes, imaging modalities and detection devices) and expertise of various clinical specialties (i.e., Nuclear Medicine, Oncology, Pathology, Radiology, Radiation Oncology and Surgery) for precision diagnosis and optimal treatment. Although the diagnosis and treatment of colorectal adenocarcinoma was the focus throughout the System’s development, it is applicable to other adenocarcinomas. Developing the System to increase the precision in the surgical management of colorectal adenocarcinoma began with the selection of the tumor-related antigen, tumor associated glycoprotein-72 (TAG-72). Generations of anti-TAG-72 monoclonal antibodies radiolabeled with 125I were safely used as molecular probes. During surgery, a hand-held gamma probe was used for the detection and excision of TAG-72 positive tissues. Long term follow-up of patients with primary colorectal adenocarcinoma demonstrated a survival advantage in those who TAG-72 “Status @ Closing” was negative. Our proof-of-concept studies demonstrated that this System increases the surgical precision, and thus the quality of care, for individual patients. The proposed use of bioengineered anti-TAG-72 monoclonal antibody fragments radiolabeled with 123I for hand-held gamma probe detection along with pre- and post-resection intraoperative gamma imaging would more precisely answer the question, “Did you get it all?” for those patients with colorectal and other adenocarcinomas.
Hitchcock CL, Magliery TJ, Mojzisik C, Johnson M, Arnold MW, Martin EW. Evolution of a System to Increase Precision in the Surgical Management of Colorectal Carcinoma. Clin Surg. 2017; 2: 1491.