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）：本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）对脑肿瘤进行MRI引导的精确靶向和精确消融。25-40%的全身性癌症患者遭受脑转移（BM）的影响。BM的治疗通常是多学科的，包括开放手术、立体定向放射外科手术（SRS）、全脑放疗和/或化疗。一部分患者是开放手术和/或SRS的候选者。在适当的患者中通过开颅手术进行开放手术，可以进行组织诊断，快速缓解症状和局部疾病控制。SRS的优点是它是非侵入性的，避免了与开颅手术相关的并发症。然而，SRS排除了组织诊断，症状缓解的时间较慢。拟议研究的目的是提供一套完整的新工具，通过不到一英寸的切口靶向和消融肿瘤，提供开颅手术的好处。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（<1 mm）和适形消融。所提出的方法是结合联合收割机的实时MR引导的机器人辅助输送的iHIFU与MR热成像（MRTI）的反馈。该系统使用MR兼容的机器人操纵器，能够以使该治疗成为合理辅助所需的准确性、再现性和效率输送套管，而间质性高强度超声允许高度精确的电子可配置治疗消融，具有精确体积的能力（尺寸和形状）控制，从非常小（mm）到中等（几厘米）的尺寸，而不损害附近与疾病无关的关键结构。所提出的方法的重要性在于， 提供了开颅术的微创替代方案，其提供了优于SRS的优点，即允许组织诊断以及在难以到达的人脑区域中的立即肿瘤消融。拟议工作的临床重点是脑转移瘤（BM），这些转移瘤是实体的，与周围组织界限分明，适合MR引导消融。预计这种新型和高度可控的消融系统的成功开发将最终导致未来治疗其他类型肿瘤（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器械，2）构建和评估MRI兼容的操纵器，用于神经消融器械输送和控制，3）开发和集成基于计算机的3D治疗计划和模拟工具，以及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损伤。该项目的成功完成将导致与兽医医院的实验方案到位，使用iHIFU作为脑转移犬治疗范例的一部分，不久将进行人体研究。