Surgeon-performed Ultrasound for Real-time Guidance In Oral Cancer Surgeries - A Multicenter Randomized Controlled Trial
NCT ID: NCT07203911
Last Updated: 2025-10-02
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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RECRUITING
NA
200 participants
INTERVENTIONAL
2025-09-15
2031-08-31
Brief Summary
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Participants will be randomized to either the control or intervention group:
* Control group will receive standard treatment for oral cancer.
* Intervention group will in addition to the standard treatment have surgery performed using ultrasound to guide the resection and evaluate resection margins intraoperatively.
Outcomes:
* Number of free surgical margins between control and intervention group.
* Intraoperative surgeon assessed surgical margins compared to final histology report.
* Dysphagia and quality of life questionnaires.
* Recurrence rates.
* Mortality rates.
All participant will be followed-up at 3 months and 12 months with:
* MDADI dysphagia questionnaire
* EORTC head and neck cancer quality of life questionnaire
* Follow-up on recurrrence and mortality.
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Detailed Description
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Surgery is the primary treatment for early-stage oral cancer, aiming to completely remove the tumor along with a margin of healthy tissue to ensure a clear surgical margin. However, in up to 50% of cases, the tumor is not entirely removed, leading to higher rates of cancer recurrence and mortality. This challenge often arises from difficulty distinguishing tumor tissue from healthy tissue during the operation. Studies have shown that ultrasound can effectively make this distinction. This project investigates using B-mode in-vivo and ex-vivo ultrasound to assist surgeons in the resection of the tumor. The objective is to enhance accuracy during these surgeries by use of ultrasound. Consequently, we hope to minimize the need for adjuvant therapies, potentially enhancing patients' quality of life and reducing cancer recurrence and mortality rates.
Study population:
Inclusion criteria
• Patients scheduled for surgical treatment of biopsy-proven T1-T3 oral squamous cell carcinoma.
Exclusion criteria
* Age \< 18 years.
* Oral cancer with suspected bone involvement.
* Unable to understand verbal or written information.
* Prior radiotherapy treatment of oral cavity cancer.
* Tumor not visible on ultrasound.
Methods:
We plan to conduct a multicenter randomized controlled trial at seven otorhinolaryngology-Head and Neck Surgery departments in Europe, USA and Africa. The trial is anchored in Rigshospitalet, Copenhagen (Denmark).
Patients who meet the study´s criteria will be assigned either the control - or intervention group.
* Patients in the control group will have surgery for oral cancer conducted following the current standards for each center. The oral cancer tumor will be excised without having an ultrasound machine available to guide the resection. Then, the surgeon will take additional biopsies either from the in-vivo wound edges or from the specimen depending on local guidelines. Then the biopsies will be sent to the pathology department for frozen-section analysis. The surgeon might revise the resection or terminate the operation based on the frozen-section result. If the frozen-section analysis indicates an inadequate margin, the surgeon will, if possible, excise additional tissue from the wound, and the measured margin will be adjusted accordingly.
* In the intervention group, surgeons will have both in-vivo and ex-vivo ultrasound at their disposal to guide the resection and evaluate surgical margins during the procedure. The in-vivo ultrasound will be employed in real-time on the tumor to guide the resection process. Initially, tumor dimensions are measured using a Fujifilm robotic ultrasound probe or a hockey stick probe, and a 10 mm margin is marked from the tumor's boundaries. The surgeon begins the resection, periodically pausing to obtain real-time images of the resection plane. This is done by repositioning the partially resected specimen, making the resection plane visible as a hyperechoic border on the ultrasound, or by placing a small surgical instrument between the tumor/host interface to visualize the resection plane. Alternatively, the partially resected tumor can be ultrasound scanned from inside-out making the surgical margin visible nearest to the transducer. This is repeated until the tumor is completely removed.
After tumor removal, the specimen will undergo an ex-vivo ultrasound scan. In this phase, we will use a motorized mechanical transducer holder to hold the transducer to obtain standardized and reproducible B-mode cross-sectional images of the resected tissue allowing for margin measurement in the operating room. This imaging along with the margin measurements will help surgeons decide whether to perform an immediate re-resection or to conclude the operation. The use of ultrasound will not replace standard procedures, but should instead be viewed as an add-on tool. Therefore, surgeons in the intervention group will have the possibility to take biopsies for frozen section analyses.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
DOUBLE
Study Groups
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Control
The patients in the control group will have surgery for oral cancer conducted following the current standards for each center.
Standard Treatment
Standard surgical treatment of oral cancer
Intervention
In the intervention group, surgeons will have both in-vivo and ex-vivo ultrasound at to guide the resection and evaluate surgical margins during the procedure. The in-vivo ultrasound will be employed in real-time on the tumor to guide the resection process. The surgeon begins the resection, periodically pausing to obtain real-time images of the resection plane using ultrasound. This is done by repositioning the partially resected specimen, making the resection plane visible as a hyperechoic border on the ultrasound, or by placing a small surgical instrument between the tumor/host interface to visualize the resection plane. Alternatively, the partially resected tumor can be ultrasound scanned from inside-out making the surgical margin visible nearest to the transducer. This is repeated until the tumor is completely removed.
Ultrasound imaging
Ultrasound will be performed during surgery in two phases: 1) in-vivo and 2) ex-vivo. In the in-vivo phase surgeons will perform intraoral ultrasound with a small intraoral transducer in order to visualize size and boundaries of tumor. Then the surgeon begins the resection periodically pausing to obtain real-time images of the resection plane and determin if resection is performed at safe distance to the tumor. In the ex-vivo phase the resected tumor will undergo ultrasound by using a motorized mechanical arm designed to hold an ultrasound transducer. This ensures standardized and reproducible scans. The purpose of the ex-vivo scan is to measure the surgical margins at the operating theatre and allow for an immediate re-resection of necessary. Surgeons in the intervention group will also have the possibility of taking biopsies for frozen section analyses.
Interventions
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Ultrasound imaging
Ultrasound will be performed during surgery in two phases: 1) in-vivo and 2) ex-vivo. In the in-vivo phase surgeons will perform intraoral ultrasound with a small intraoral transducer in order to visualize size and boundaries of tumor. Then the surgeon begins the resection periodically pausing to obtain real-time images of the resection plane and determin if resection is performed at safe distance to the tumor. In the ex-vivo phase the resected tumor will undergo ultrasound by using a motorized mechanical arm designed to hold an ultrasound transducer. This ensures standardized and reproducible scans. The purpose of the ex-vivo scan is to measure the surgical margins at the operating theatre and allow for an immediate re-resection of necessary. Surgeons in the intervention group will also have the possibility of taking biopsies for frozen section analyses.
Standard Treatment
Standard surgical treatment of oral cancer
Eligibility Criteria
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Inclusion Criteria
Exclusion Criteria
* Oral cancer with suspected bone involvement.
* Unable to understand verbal or written information.
* Prior radiotherapy treatment of oral cavity cancer.
* Tumor not visible on ultrasound.
18 Years
ALL
No
Sponsors
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Karolinska Institutet
OTHER
Emory University
OTHER
Stanford University
OTHER
National Cancer Institute, Milan
OTHER
University of Cape Town
OTHER
Aarhus University Hospital
OTHER
Tobias Todsen
OTHER
Responsible Party
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Tobias Todsen
MD, PhD, Ass. Prof.
Locations
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Stanford Otolaryngology - Head & Neck Surgery Department
Stanford, California, United States
Emory University Hospital
Atlanta, Georgia, United States
Department of Otorhinolaryngology Head and Neck Surgery
Aarhus, , Denmark
Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet
Copenhagen, , Denmark
Istituto Nazionale Tumori of Milan
Milan, , Italy
Groote Schuur
Cape Town, , South Africa
Karolinska Institute
Stockholm, , Sweden
Countries
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Central Contacts
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Facility Contacts
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Other Identifiers
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p-2024-18099
Identifier Type: -
Identifier Source: org_study_id
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