Precise MRI-Directed Sonic Ablation of Prostate Cancer

描述(由申请人提供)：该项目的长期目标是开发一种微创、有效和安全的前列腺癌治疗方法。我们的具体目标是1)优化用于前列腺消融的经尿道高强度超声喷射器，2)在犬模型中严格评估喷射器，包括研究MR引导下前列腺消融的准确性，并了解孤立性前列腺的长期(6周)结局3)评估MR引导下经尿道高强度超声与经直肠HIFU进行靶向前列腺消融的相对优势和差异，4)评估我们的喷射器在MRI引导下对人类受试者局部切除选定前列腺组织的能力，并证明患者是安全的。在美国，前列腺癌是男性最常见的恶性肿瘤，皮肤癌除外。我们目前正在开发的技术是为前列腺癌的局部控制而设计的(即通过切除前列腺组织来控制主要过程本身)，由于目前高达88%的前列腺癌表现为器官受限疾病，因此这些治疗方法将适用于大多数新出现的病例。聚焦超声是下一代非侵入性肿瘤治疗系统的一种很有前途的技术。利用这项技术，超声波能量被集中在身体深处的某个点上，以热消融目标组织。这可以在皮肤或空洞表面以最小的热沉积来完成，而不需要穿孔或切开。这里提出的努力解决了使用经尿路聚焦超声治疗的主要技术挑战。这种敷贴器将被开发成将聚焦超声治疗与磁共振图像引导相结合，以允许将热能精确地定向到目标组织。将开发通过精确的温度映射来监测前列腺目标区域的热沉积的技术，以确保整个目标体积正在接受治疗，并确定诸如直肠、神经血管束和尿路等关键结构保持足够的温度以避免损伤。新的涂抹器和系统将在体外和体内进行开发和评估。公共卫生意义：我们将开发和测试一种综合系统，用于控制前列腺癌的消融，使用在mri热成像引导下向前列腺发射高强度超声的经尿路设备，并结合直肠和尿路冷却。

DESCRIPTION (provided by applicant): The long-term goal of this project is to develop a minimally invasive, effective, and safe treatment for prostate cancer. Our specific aims are to 1) to optimize transurethral high intensity ultrasonic applicators for prostate ablation, 2) to rigorously evaluate the applicators in a canine model, including study of the accuracy of MR-guidance of ablation and elucidation of longer-term (6 weeks) fate of insonated prostate 3) to evaluate the relative advantages and differences of MR-guided transurethral high- intensity ultrasound compared to transrectal HIFU for targeted prostate ablation, 4) to evaluate the ability of our applicators to locally ablate selected prostate tissues under MRI guidance in human subjects with demonstrated patient safety. In the US, prostate cancer is the most common malignancy in men, excluding skin cancer. The techniques we are currently developing are designed for local control of prostate cancer (i.e., control of the primary process itself by ablation of prostatic tissues), and since up to 88% of prostate cancers are currently presenting as organ-confined disease, these therapies would thus be applicable to the majority of newly presenting cases. Focused ultrasound is a promising technique for the next generation of non- invasive cancer therapy systems. With this technology, ultrasound energy is focused at a point deep within the body to thermally ablate targeted tissue. This can be done with minimal heat deposition from the skin or cavity surface, without puncture or incision. The effort proposed here addresses the main technical challenges to using transurethral focused ultrasound therapy. The applicators will be developed to couple focused ultrasound treatment with Magnetic Resonance image guidance to allow precise targeting of the thermal energy to target tissues. Techniques to monitor heat deposition in targeted regions of the prostate gland, through accurate temperature mapping will be developed to insure that the entire target volume is being treated, and to ascertain that critical structures such as the rectum, the neurovascular bundles, and the urethra remain sufficiently cool to avoid damage. The new applicators and systems will be developed and evaluated both in vitro and in vivo. PUBLIC HEALTH RELEVANCE: We will develop and test an integrated system for the controlled ablation of prostate cancer using transurethral devices delivering high-intensity ultrasound to the prostate, directed by MRI thermal imaging, and incorporating rectal and urethral cooling