MR-Guided Precision Conformal Ablation Therapy for Brain Tumors

MR 引导脑肿瘤精准适形消融治疗

• 批准号: 8663200
• 负责人: GREGORY S FISCHER
• 金额: $ 59.17万
• 依托单位: WORCESTER POLYTECHNIC INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-17 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8663200
• 关键词: Ablation; Acute; Address; Anatomy; Animal Hospitals; Animal Model; Animals; Automation; Brain; Brain Neoplasms; Cadaver; Caliber; Canis familiaris; Cannulas; Cardiac ablation; Clinical; Computers; Cranial Irradiation; Craniotomy; Development; Devices; Diagnosis; Disease; Dose; Environment; Feedback; Focused Ultrasound Therapy; Future; Gadolinium; Goals; Heating; Human; Image; Imagery; Intervention; Lead; Lesion; Magnetic Resonance Imaging; Malignant Neoplasms; Metastatic malignant neoplasm to brain; Methods; Monitor; Operative Surgical Procedures; Pathway interactions; Patients; Protocols documentation; Radiation; Radiation therapy; Radiosurgery; Recovery; Reproducibility; Research; Robot; Robotics; Shapes; Site; Solid; Structure; Surgical incisions; Symptoms; System; Technology; Therapeutic; Time; Tissues; Toxic effect; Transducers; Ultrasonics; Ultrasonography; Work; base; brain surgery; brain tissue; cancer therapy; cancer type; chemotherapy; clinically relevant; cranium; disorder control; flexibility; gadolinium oxide; in vivo; instrument; interstitial; meningioma; multidisciplinary; neurofibroma; neurosurgery; novel; novel strategies; pre-clinical; public health relevance; rapid diagnosis; research clinical testing; robot assistance; robotic device; simulation; tool; treatment planning; treatment strategy; tumor

DESCRIPTION (provided by applicant): The goal of this project is to develop an integrated system for MRI-guided precise targeting and accurate ablation of brain tumors by interstitial high intensity focused ultrasound (iHIFU). Between 25-40% of patients with systemic cancer suffer the effect of brain metastases (BM). Treatment of BMs is often multidisciplinary involving open surgery, stereotactic radiosurgery (SRS), whole brain radiation, and/or chemotherapy. A subset of patients are candidates for open surgery and/or SRS. Open surgery via craniotomy in appropriate patients allows for tissue diagnosis, rapid relief of symptoms, and local disease control. The advantage of SRS is that it is non-invasive and avoids complications associated with craniotomy. SRS, however, precludes tissue diagnosis and time to symptom relief is slower. The purpose of the proposed research is to provide a complete new set of tools offering the benefits of craniotomy less invasively by targeting and ablating tumors through an incision less than one inch. The complete set of tools to deliver this therapy thus requires adequate visualization, precise targeting (<1mm), and conformal ablation. The proposed approach is to combine real-time MR-guided robot-assisted delivery of iHIFU with MR thermal imaging (MRTI) feedback. The system uses an MR-compatible robotic manipulator capable of delivering a cannula with the accuracy, reproducibility and efficiency needed to make this therapy a reasonable adjunct, while interstitial high-intensity ultrasound allows for highly precise electronically configurable therapeutic ablation with capability for exact volume (size and shape) control in 3D, from very small (mm) to moderate (several cm) size, without harming nearby critical structures not involved with disease. The significance of the proposed approach is that it offers a less invasive alternative to craniotomy, which provides the advantage over SRS of allowing for tissue diagnosis as well as immediate tumor ablation in difficult to reach regions of the human brain. The clinical focus of the proposed work is on brain metastases (BM), which are solid, well-demarcated from surrounding tissue, and amenable to MR-guided ablations. It is anticipated that successful development of this novel and highly controllable ablation system will eventually lead to future approaches to treat other types of tumors such as meningiomas. The aims of this project are to: 1) develop a MRI-compatible interstitial ultrasonic neuroablation instrument, 2) construct and evaluate an MRI-compatible manipulator for neuroablation instrument delivery and control, 3) develop and integrate computer-based 3D treatment planning and simulation tools, and 4) perform pre-clinical evaluations to confirm accuracy, optimize clinical workflow, and demonstrate successful ablative lesioning in clinically-relevant environment. Successful completion of this project will result in an experimental protocol in place with a veterinary hospital to use iHIFU as part of a treatment paradigm for canines with brain metastases, with human studies soon to follow.

描述（由申请人提供）：该项目的目标是开发一种集成系统，用于通过间质高强度聚焦超声（iHIFU）在 MRI 引导下精确定位和精确消融脑肿瘤。 25-40% 的全身性癌症患者会遭受脑转移 (BM) 的影响。脑转移的治疗通常是多学科的，包括开放手术、立体定向放射外科 (SRS)、全脑放射和/或化疗。一部分患者适合接受开放手术和/或立体定向放射外科手术。对适当的患者进行开颅手术可以进行组织诊断、快速缓解症状和控制局部疾病。 SRS 的优点是它是非侵入性的，并且避免了开颅手术相关的并发症。然而，SRS 排除了组织诊断，而且症状缓解的时间也较慢。拟议研究的目的是提供一套全新的工具，通过小于一英寸的切口瞄准和消融肿瘤，从而提供微创开颅手术的好处。因此，提供这种治疗的全套工具需要足够的可视化、精确的靶向（<1mm）和适形消融。所提出的方法是将实时 MR 引导机器人辅助的 iHIFU 输送与 MR 热成像 (MRTI) 反馈相结合。该系统使用与 MR 兼容的机器人操纵器，能够以使该疗法成为合理辅助疗法所需的准确性、可重复性和效率来输送插管，而间质高强度超声可实现高精度的电子可配置治疗消融，并具有精确体积的能力。尺寸和形状）以 3D 方式进行控制，从非常小（毫米）到中等（几厘米）尺寸，而不会损害附近与疾病无关的关键结构。所提出方法的意义在于 开颅手术提供了一种侵入性较小的替代方案，与 SRS 相比，它的优势在于可以进行组织诊断，并可以在难以到达的人脑区域立即进行肿瘤消融。这项工作的临床重点是脑转移瘤 (BM)，这种转移瘤是实心的，与周围组织界限清楚，并且适合 MR 引导的消融。预计这种新型且高度可控的消融系统的成功开发最终将导致未来治疗其他类型肿瘤（例如脑膜瘤）的方法。该项目的目标是：1) 开发 MRI 兼容的间质超声神经消融仪器，2) 构建和评估用于神经消融仪器输送和控制的 MRI 兼容机械手，3) 开发和集成基于计算机的 3D 治疗计划和模拟工具，4) 进行临床前评估，以确认准确性、优化临床工作流程，并在临床相关环境中展示成功的消融性病变。该项目的成功完成将导致与一家兽医医院达成一项实验协议，使用 iHIFU 作为脑转移犬类治疗范例的一部分，人体研究很快就会跟进。