Ovarian cancer is usually diagnosed only after it has reached an advanced stage, with many tumors spread throughout the abdomen. Most patients undergo surgery to remove as many of these tumors as possible, but because some are so small and widespread, it is difficult to eradicate all of them.
Researchers at MIT, working with surgeons and oncologists at Massachusetts General Hospital (MGH), have now developed a way to improve the accuracy of this surgery, called debulking. Using a novel fluorescence imaging system, they were able to find and remove tumors as small as 0.3 millimeters — smaller than a poppy seed — during surgery in mice. Mice that underwent this type of image-guided surgery survived 40 percent longer than those who had tumors removed without the guided system.
“What’s nice about this system is that it allows for real-time information about the size, depth, and distribution of tumors,” says Angela Belcher, the James Mason Crafts Professor of Biological Engineering and Materials Science at MIT, a member of the Koch Institute for Integrative Cancer Research, and the recently appointed head of MIT’s Department of Biological Engineering.
The researchers are now seeking FDA approval for a phase 1 clinical trial to test the imaging system in human patients. In the future, they hope to adapt the system for monitoring patients at risk for tumor recurrence, and eventually for early diagnosis of ovarian cancer, which is easier to treat if it is caught earlier.
Belcher and Michael Birrer, formerly the director of medical gynecologic oncology at MGH and now the director of the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, are the senior authors of the study, published online in the journal ACS Nano on April 22.
Neelkanth Bardhan, a Mazumdar-Shaw International Oncology Fellow at the Koch Institute, and Lorenzo Ceppi, a researcher at MGH, are the lead authors of the paper. Other authors include MGH researcher YoungJeong Na, MIT Lincoln Laboratory technical staff members Andrew Siegel and Nandini Rajan, Robert Fruscio of the University of Milan-Bicocca, and Marcela del Carmen, a gynecologic oncologist at MGH and chief medical officer of the Massachusetts General Physicians Organization.
Because there is no good way to detect early-stage ovarian cancer, it is one of the most difficult types of cancer to treat. Of 250,000 new cases diagnosed each year worldwide, 75 percent are in an advanced stage. In the United States, the five-year combined survival rate for all stages of ovarian cancer is 47 percent, only a slight improvement from 38 percent three decades ago, despite the advent of chemotherapeutic drugs such as cisplatin, approved by the FDA in 1978 for ovarian cancer treatment. In contrast, the five-year combined survival rate for all stages of breast cancer has steadily improved, from around 75 percent in the 1970s to over 90 percent now.
“We desperately need better upfront therapies, including surgery, for these (ovarian cancer) patients,” Birrer says.
Belcher and Birrer joined forces to work on this problem through the Bridge Project, a collaboration between the Koch Institute and Dana-Farber/Harvard Cancer Center. Belcher’s lab has been developing a novel type of medical imaging based on light in the near-infrared (NIR) spectrum. In a paper published in March, she reported that this imaging system could achieve an unprecedented combination of resolution and penetration-depth in living tissue.
In the new study, Belcher, Birrer, and their colleagues worked with researchers at MIT Lincoln Laboratory to adapt NIR imaging to help surgeons locate tumors during ovarian cancer surgery, by providing continuous, real-time imaging of the abdomen, with tumors highlighted by fluorescence. Previous analyses have shown that survival rates are strongly inversely correlated with the amount of residual tumor mass left behind in the patient during debulking surgery, but many ovarian tumors are so small or hidden that surgeons can’t find them.
To make the tumors visible, the researchers designed chemical probes using single-walled carbon nanotubes that emit fluorescent light when illuminated by a laser. They coated these nanotubes with a peptide that binds to SPARC, a protein that is overexpressed by highly invasive ovarian cancer cells. This probe binds to the tumors and makes them fluoresce at NIR wavelengths, allowing surgeons to more easily find them with fluorescence imaging.
The researchers tested the image-guided system in mice that had ovarian tumors implanted in a region of the abdominal cavity known as the intraperitoneal space, and showed that surgeons were able to locate and remove tumors as small as 0.3 millimeters. Ten days after surgery, these mice had no detectable tumors, while mice that had undergone the traditional, non-image-guided surgery, had many residual tumors missed by the surgeon.
By three weeks after the surgery, many of the tumors had grown back in the mice that underwent image-guided surgery, but those mice still had a median survival rate that was 40 percent longer than that of mice that underwent traditional surgery.
No other imaging system would be able to locate tumors that small during a surgical procedure, the researchers say.
“You can’t have a patient in a CT machine or an MRI machine and have the surgeon perform this surgical debulking procedure at the same time, and you can’t expose the patient to X-ray radiation for multiple hours of the long surgery. This optics-based imaging system allows us to do that in a safe manner,” Bardhan says.
Alessandro Santin, a professor of obstetrics and gynecology and clinical research program leader at the Yale University School of Medicine, described the results as “intriguing.”
“These data support the potential use of this novel imaging system in the intraoperative setting for the optical detection of residual malignant tissue at the time of surgical staging, and/or cytoreductive surgery in ovarian cancer patients,” says Santin, who was not involved in the study.
For most ovarian cancer patients, tumor debulking surgery is followed by chemotherapy, so the researchers now plan to do another study where they treat the mice with chemotherapy after image-guided surgery, in hopes of preventing the remaining tiny tumors from spreading.
“We know that the amount of tumor removed at the time of surgery for patients with advanced-stage ovarian cancer is directly correlated with their outcome,” Birrer says. “This imaging device will now allow the surgeon to go beyond the limits of resecting tumors visible to the naked eye, and should usher in a new age of effective debulking surgery.”
Now that they have demonstrated that this concept can be successfully applied to imaging during surgery, the researchers hope to begin adapting the system for use in human patients.
“In principle, it’s quite doable,” Siegel says. “It’s purely the mechanics and the funding at this point, because this mouse experiment serves as the proof of principle and may actually have been more challenging than building a human-scale system.”
The researchers also hope to deploy this type of imaging to monitor patients after surgery, and eventually to develop it as a diagnostic tool for screening women at high risk for developing ovarian cancer.
“A major focus for us right now is developing the technology to be able diagnose ovarian cancer early, in stage 1 or stage 2, before the disease becomes disseminated,” Belcher says. “That could have a huge impact on survival rates, because survival is related to the stage of detection.”
The Latest on: Image-guided surgery
via Google News
The Latest on: Image-guided surgery
- 2019 Report on Image-guided Navigation Technologies Providing Surgical Guidance: Market Segmentation, Key Application Areas, Opportunities for R&D Funon August 15, 2019 at 2:31 am
DUBLIN--(BUSINESS WIRE)--The "Image-guided Navigation Technologies Providing Surgical ... Private Funding Over the Last 5 Years 4.2 Notable Private Funding in Advanced Surgery Tech Space 4.3 Advanced ...
- Image-guided Navigation Technologies Providing Surgical Guidance, 2019 - AI & Tactile Feedback are Key to the Growth of Robotic Surgeryon August 15, 2019 at 2:24 am
Dublin, Aug. 15, 2019 (GLOBE NEWSWIRE) -- The "Image-guided Navigation Technologies Providing Surgical Guidance" report has been added to ResearchAndMarkets.com's offering. This research service ...
- Siemens to acquire robotic surgery systems maker Corindus for $1.1 billionon August 13, 2019 at 4:30 pm
“With this acquisition, we are opening up a new field for our image-guided therapies business. Together with our strong portfolio in imaging, digitalization and artificial intelligence, we are ...
- On Target Laboratories Announces Leadership Transition and Appoints Christopher Barys as Chief Executive Officeron August 12, 2019 at 5:23 am
"I look forward to advancing the company's mission of revolutionizing image-guided surgery with this transformative technology. The products we are developing will provide surgeons new approaches ...
- Telix Pharma teams up with DKFZ for prostate surgeryon August 5, 2019 at 4:46 am
Telix Pharmaceuticals (OTC:TLPPF) has entered into a collaboration agreement with the German Cancer Research Center (Deutsches Krebsforschungszentrum or DKFZ) in the field of image-guided surgery ...
- Telix Pharmaceuticals and German Cancer Research Center (DKFZ) Enter into Collaboration and Option Agreement for Image-Guided Prostate Surgeryon August 4, 2019 at 5:00 pm
(GLOBE NEWSWIRE via COMTEX) -- MELBOURNE, Australia and HEIDELBERG, Germany, Aug. 05, 2019 (GLOBE NEWSWIRE) -- Telix Pharmaceuticals Limited (ASX.TLX) ("Telix", the "Company"), a clinical-stage ...
- Image-Guided Endoscopic Spine Surgery: Part I. A Feasibility Studyon July 31, 2019 at 5:00 pm
Study Design. A feasibility study was performed to determine the efficacy of computer assistance in endoscopic spine surgery. Objectives. To assess a new method for computer assistance based on image ...
- Titan Medical Reports First Use of SPORT Surgical System in Europe at the Institute of Image-Guided Surgery of Strasbourgon July 17, 2019 at 7:42 am
Before it's here, it's on the Bloomberg Terminal.
- OnLume raises funds for system that makes fluorescence image-guided surgery possible under bright lightson June 25, 2019 at 9:29 am
Medical device company OnLume obtained $749,000 in its first round of venture funding on May 17, 2019 from an undisclosed source to further develop its platform. This spinoff company from the ...
- Image Guided Surgery Devices Market in-Depth Analysis 2019-2026 by Top Players: Bainlab, Stryker, Siemens, Medtronic, Brainlabon June 24, 2019 at 8:26 am
This Image Guided Surgery Devices Market report covers the size, share, trends, forecast, status of import and export, supply chain management, distribution channels, production volume, production ...
via Bing News