Ultrasound Ablation on Bone Cancer Under CT Fluoroscopy

CT透视下骨癌超声消融

基本信息

批准号：
8082600
负责人：
Everette C Burdette
金额：
$ 109.64万
依托单位：
ACOUSTIC MEDSYSTEMS, INC.
依托单位国家：
美国
项目类别：
财政年份：
2005
资助国家：
美国
起止时间：
2005-09-21 至 2013-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8082600
关键词：
Ablation Acoustics Adult Affect Aftercare Algorithms Anatomy Anesthesia procedures Animal Model Animals Anti-Inflammatory Agents Anti-inflammatory Area Atelectasis Back Pain Bed rest Biomedical Research Bone Diseases Bone neoplasms Braces-Orthopedic appliances Caliber California Cancer Model Cancer Patient Cannulas Cardiopulmonary Cervical Clinical Clinical Research Collaborations Common Neoplasm Compression Fracture Computer software Computers Conduction Anesthesia Data Deep Vein Thrombosis Deposition Development Devices Diagnosis Diagnostic Disease Dose Electronics Elements Equipment Evaluation Family Family suidae Feedback Financial compensation Fluoroscopy Fracture Funding General Anesthesia Grant Health Hematologic Neoplasms Hospitals Human Image Intervention Joints Learning Length Lesion Life Expectancy Local Therapy Location Lymphoma Lytic Metastatic Lesion Magnetic Resonance Imaging Malignant - descriptor Malignant Bone Neoplasm Malignant Neoplasms Malignant neoplasm of prostate Marketing Mechanics Medical Technology Metastatic Lesion Metastatic Neoplasm to the Bone Methodology Methods Modeling Monitor Morbidity - disease rate Multiple Myeloma Narcotic Analgesics Needles Neoplasm Metastasis Nerve Root Compressions Neurologic Dysfunctions Operative Surgical Procedures Osteolysis Outcome Outpatients Output Pain Palliative Care Paraparesis Paraplegia Pathological fracture Patients Pattern Penetration Performance Pharmaceutical Preparations Phase Physicians Pilot Projects Pneumonia Positioning Attribute Preparation Preventive Procedures Pulmonary Embolism Quadripareses Quadriplegia Radial Radiation therapy Radiofrequency Interstitial Ablation Radiology Specialty Radiopharmaceuticals Recovery Research Research Subjects San Francisco Scheme Secondary to Shapes Skeletal system Small Business Innovation Research Grant Small Business Technology Transfer Research Specific qualifier value Spinal Spinal Cord Spinal Neoplasms Structure Surface Symptoms System Systems Integration Techniques Technology Temperature Testing Therapeutic Therapeutic Intervention Thermal Ablation Therapy Time Tissues Toxic effect Transducers Ultrasonography United States Universities Variant Vertebral column Walking Work base bisphosphonate body system bone cancer therapy chemotherapy clinical application clinical practice computerized data processing conventional therapy cost design dosimetry flexibility high risk hormone therapy improved in vivo instrumentation interstitial intraoperative imaging killings minimally invasive mortality neoplastic neurosurgery pre-clinical prevent programs prototype research study sensor skills spinal cord compression spine bone structure standard care success technology development tomography treatment planning tumor validation studies vertebra body

项目摘要

DESCRIPTION (provided by applicant): Metastatic bone cancer and multiple myeloma affects over 600,000 people every year in the United States and cause progressive bone destruction that results in severe pain, fractures, and the inability to walk. Patients usually present with incapacitating pain secondary to osseous involvement, with or without vertebral collapse, and to spinal cord and/or nerve roots compression, commonly leading to paraplegia and quadriplegia. Conventional therapy consists of bed rest, bracing, anti-inflammatory, or narcotic analgesic medications, and radiation therapy. These conservative options (except radiation therapy) are not dissimilar from the management of osteoporotic compression fractures and are associated with the same type of complications, i.e., atelectasis and pneumonia, deep venous thrombosis and pulmonary embolism. Surgical options are not possible for all patients, but when indicated, they consist of heavy interventions such as corpectomy or cage placement, with significant postprocedural recovery periods and high morbidity and mortality rates in patients who often have limited life expectancies. In addition, multifocal vertebral lesions are common and may contraindicate surgery. Vertebroplasty affects the pain symptom and was not designed to treat cancer. Current options for local treatment of metastatic spine cancer are insufficient. The hypothesis is that thermal ablation with high intensity interstitial ultrasound (HIIU) specifically matched to the tumor size and shape can be safe and efficacious in the management of metastatic spine cancer. We propose to develop a mechanism to perform minimally invasive conformal ultrasound ablation under combined computer tomography (CT) and CT fluoroscopy (CTF) guidance. Our work indicates that this method may provide a consistent, reliable, and safe treatment option in a simple and cost-efficient manner. The unique aspect of our approach is the ability to destruct an asymmetric target volume with a single needle that does not need to be placed in the center of the lesion. Under CT/CTF image guidance, we insert the ablator, localize the ablator with respect to the target zone, and then electronically shape the energy output to conform the target. Thus moderate placement errors can be simply corrected electronically. We also can ablate difficult shapes located nearby sensitive structures. There is a strong clinical need to deliver a means to kill the tumor in a focused and safe way in this sensitive area, protecting the spinal cord, around which the tumor is likely to have caused significant bone destruction already. The ability to conform the energy to the shape of the tumor with a sharply defined fringe field is critical and would add very significant clinical value. This program will develop an integrated instrumentation - ablative treatment delivery system, establish safe and accurate percutaneous HIIU needle placement and tumor ablation under real-time quantitative CT/CTF guidance, develop appropriate clinical workflow, and demonstrate use in clinical application.

描述（由申请人提供）：在美国，转移性骨癌和多发性骨髓瘤每年影响超过 600,000 人，导致进行性骨质破坏，导致严重疼痛、骨折和无法行走。患者通常会出现继发于骨质受累、伴有或不伴有椎体塌陷以及脊髓和/或神经根受压的丧失能力的疼痛，通常导致截瘫和四肢瘫痪。常规治疗包括卧床休息、支撑、抗炎或麻醉镇痛药物以及放射治疗。这些保守选择（放射治疗除外）与骨质疏松性压缩骨折的治疗没有什么不同，并且与相同类型的并发症相关，即肺不张和肺炎、深静脉血栓形成和肺栓塞。手术选择并非适用于所有患者，但当有需要时，它们包括大量干预措施，例如椎体切除术或笼置入术，术后恢复期较长，并且预期寿命通常有限的患者的发病率和死亡率较高。此外，多灶性椎体病变很常见，可能不适合手术。椎体成形术会影响疼痛症状，并不是为了治疗癌症而设计的。目前转移性脊柱癌局部治疗的选择还不够。假设是，使用与肿瘤大小和形状专门匹配的高强度间质超声（HIIU）热消融可以安全有效地治疗转移性脊柱癌。我们建议开发一种机制，在计算机断层扫描（CT）和 CT 透视（CTF）相结合的指导下进行微创适形超声消融。我们的工作表明，这种方法可以以简单且经济高效的方式提供一致、可靠和安全的治疗选择。我们方法的独特之处在于能够用不需要放置在病变中心的单针破坏不对称的目标体积。在 CT/CTF 图像引导下，我们插入烧蚀器，将烧蚀器相对于目标区域定位，然后以电子方式调整能量输出以符合目标。因此，中等的放置错误可以通过电子方式简单地纠正。我们还可以烧蚀位于敏感结构附近的困难形状。临床迫切需要提供一种方法，以集中且安全的方式杀死这个敏感区域的肿瘤，保护脊髓，肿瘤可能已经在脊髓周围造成了严重的骨质破坏。使能量与具有清晰边缘场的肿瘤形状一致的能力至关重要，并且将增加非常重要的临床价值。该项目将开发集成的仪器-消融治疗输送系统，在实时定量CT/CTF引导下建立安全、准确的经皮HIIU针放置和肿瘤消融，开发适当的临床工作流程，并在临床应用中展示使用。