International clinical trial to test the use of dye during children’s cancer surgery

Surgery is an important part of the treatment for many young people with cancer, but it does not always go as planned. Parts of the tumour can be left behind or missed, other organs can be damaged when the surgeon tries to get all the tumour out.

The cancer may have also spread to the lymph nodes, which then might need to be removed to look for disease. However, lymph nodes can be difficult to find, and sometimes tissue which looks like lymph nodes is removed but turns out not to be a lymph node when checked under the microscope.

Mr Max Pachl from the Cancer Research UK Clinical Trials Unit at the University of Birmingham wants to find out if using a dye called Indocyanine Green (ICG) can help surgeons identify tumours and lymph nodes during surgery. Indocyanine Green is a dye which becomes fluorescent when looked at with near infra-red light from special cameras. It can be injected into the bloodstream before surgery and collects within the tumour. This means the surgeon can see exactly where the tumour is, making it easier to remove all of it and to avoid damaging to healthy organs.

Indocyanine Green dye can also be injected into the tissue where the tumour is growing to see if the dye also collects in nearby lymph nodes. This makes them easier to see and remove.

The research team will look at children with rhabdomyosarcoma, other types of sarcoma, neuroblastoma, germ cell tumour or any other tumour that needs surgically removing. A computer will randomly choose which patients will have Indocyanine Green used in their surgery and which will not. This is so that the results can show if there is a difference between using the dye and not, such as less damage to healthy tissue or more tumour successfully removed, without any human bias. Mr Max Pachl hopes that the results will show whether using the dye makes surgery easier, better, and safer so that more children can be helped.