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The commercially available monoclonal antibody directed at EGFR—cetuximab—is one of a few new chemotherapeutic agents approved by the FDA for systemic therapy. Dr. Rosenthal and his team successfully conjugated a near-infrared optical dye, IRDye800, to the monoclonal antibody to EGFR (cetuximab-IRDye800) and confirmed the feasibility and safety of this approach. This work has the potential to significantly alter the way surgery is performed. Currently, surgeons must make crude estimates of what a “safe” margin should be for each patient Using Dr. Rosenthal’s approach, surgery can be more precise, identifying subclinical disease that may be missed with the naked eye or even surgical microscopes, but are present at the molecular level. Such clinically hidden disease or molecular “pre-malignancy” may account for recurrence of cancer after surgery. Using conjugate dyes such as cetuximab-IRDye800 might one day permit surgery that is performed, literally, at the molecular level, precisely removing at-risk tissue along the margin of a tumor, while maximally preserving normal tissue. Such an approach might improve oncologic outcomes as well as enhance functional results following surgery. While Dr. Rosenthal is developing this approach in the easily accessible tumors of the oral cavity and pharynx, his work has broad implications within the broader field of surgery: for breast cancer, melanoma, and abdominopelvic surgery. This pioneering approach aligns closely with the mission and goals of the Stanford Cancer Institute to transform patient care.
Chronic sinusitis affects one in 10 people worldwide. The physicians at the Stanford Sinus Center, in the Division of Rhinology and Endoscopic Skull Base Surgery, evaluate “the most difficult of the difficult cases” and strive to stay at the cutting edge in the field of rhinology. Under the leadership of Division Chief Peter Hwang, MD, this specialized team provides comprehensive medical and surgical care for disorders and complex problems of the nose and paranasal sinuses, most commonly chronic sinusitis. This includes everything from computer-assisted revision endoscopic sinus surgery to minimally invasive surgery of the skull base, orbit, and optic nerve. Through research, the Division is exploring airway tissue repair and regeneration, restoration of the sense of smell, and novel therapies for chronic sinusitis. Founded in 1999, the Stanford Sinus Center was the first center on the West Coast to offer comprehensive medical and surgical care for sinus disease by fellowshiptrained rhinologists. Today, the members of the Stanford Sinus Center include three attending rhinologic surgeons—Dr. Hwang, Jayakar Nayak, MD, PhD, and Zara Patel, MD—as well as two clinical instructors and three nurse practitioners. Together they collectively see approximately 7,500 patients and perform 1,200 surgeries, yearly. The team places a strong emphasis on integrated care, including in-clinic CT scan imaging, on-site allergy management, and interdisciplinary collaboration with a rich network of Stanford specialists. According to Dr. Hwang, “We are advancing the specialty through innovative surgical approaches to sinusitis and sinonasal cancers, as well as through collaborative care with our partners in Stanford Neurosurgery, Oculoplastics, Allergy/Immunology, and Facial Pain/Headache Management. We have numerous specialists with broad expertise that come together when needed to provide state-of-the-art care for each individual patient’s needs.”
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