Oncological Engineering - A new concept in the treatment of bone metastases

在英国，大约有200万人患有癌症，这一数字在未来十年将大幅上升，达到320万。晚期(4期)癌症的一个重要并发症是转移或继发性肿瘤，这是由肿瘤细胞扩散到身体不同部位引起的。转移尤其与乳腺癌有关，乳腺癌是女性最常见的癌症，也是这一群体癌症死亡的主要原因。数字各不相同，但一些研究表明，大约50%-60%的患者在晚期癌症中会有骨转移。在生活质量是最重要的考虑因素的时候，肿瘤削弱了骨骼，并导致了患者的各种问题，特别是预后通常是晚期的。重要的问题包括剧痛和脊柱骨折，这些都会导致脊髓损伤。这些并发症往往需要进行大手术，这会严重侵蚀患者的生活质量，而预期寿命只有几个月的问题，在某些情况下，可能会提供癌症进一步扩散的机制。目前，还没有植入物来支撑骨折前的骨骼，因为我们不能确定哪些椎骨可能会失效。OncoEng将在应用核心使能工程技术的基础上，实现当前治疗技术和护理分层的范式转变。在OncoEng中实现了一种更有利于患者的方法，在这种方法中，我们预测哪些患有肿瘤的椎骨可能会在未来失效，从而能够做出明智的护理决定。先进的计算模型和成像将被用来观察肿瘤的生长，这样就可以在不同的时间点计算出对椎骨强度的预测。然后可以将这些强度与脊柱负荷进行比较，并进行骨折风险评估。在他的风险下，这些椎骨将接受特殊的植入，以支撑虚弱的骨骼并防止骨折。这种植入物只需要进行锁孔手术，不会因为漫长的恢复期或额外的疼痛而影响患者的生活质量。这项研究是为了响应NHS长期计划中的癌症战略和欧盟的抗癌计划。英国利兹大学、帝国理工学院和伦敦大学学院三所大学联合开展了这项研究，以期对这些患者的治疗方式做出重大改变。此外，我们还形成了一个由来自欧洲、美国和澳大利亚的学术、工业和临床合作者组成的国际网络(OncoEng+Network)，专注于新的建模、成像、先进材料和创新的医疗设备，以克服预测骨折和生产新植入物的挑战。这项研究的影响包括：(1)使用成像和先进的计算模型预测骨衰竭的新诊断工具，可用于这种疾病和其他疾病，如骨质疏松症；(2)可使用微创手术插入的新的患者专用植入物，减少对患者的创伤，并具有较短的恢复期(几天而不是几周或几个月)；植入物将在椎骨易骨折之前插入，(3)提供微创植入物的新制造技术，这些技术在医学以外有广泛的应用，包括航空航天和汽车行业，以及(4)脊柱植入物的新测试方法，以确保这些设备在包括高患者负荷等不利条件下的一系列活动下进行测试。重要的是，该计划拨款将培训和提高新一代工程师和科学家在基于应用的研究的新领域的技能，该领域包括骨骼癌症设备和骨折预测软件，旨在将英国和国际上的活动结合在一起，形成一个全面的综合活动。

Approximately 2 million people are living with cancer in the UK and this number is set to rise considerably over the next decade to 3.2M. A significant complication of late stage (stage 4) cancer is metastases or secondary tumours which are caused by tumour cells spreading to different locations in the body. Metastases are particularly associated with breast cancer, which is the most common cancer in females and the leading cause of cancer deaths in this group. Figures vary but some studies put a figure of about 50-60 % of patients will have bone metastases in late stage cancer. The tumours weaken the bone and lead to a variety of problems for the patients at a time when quality of life is a paramount consideration, especially as the prognosis is usually terminal. Significant issues include severe pain and spinal fracture which made lead to spinal cord injury. These complications often require major surgery which encroaches, significantly, on the patients' quality of life, when life expectancy is a matter of months and may, in certain cases, provide a mechanism of further spread of the cancer. Currently, there are no implants for supporting the bones before fracture as we cannot identify which vertebrae are likely to fail. OncoEng will deliver a paradigm shift in the current treatment technologies and stratification of care based on the application of core enabling engineering technologies. A more patient-friendly approach is realised in OncoEng in which we predict which vertebrae with tumours are likely to fail in the future enabling informed decision on care. Advanced computational modelling and imaging will be used to look at the growth of the tumour so that predictions of the strength of the vertebrae can be calculated a different points in time. These strengths can then be compared to spinal loads and an assessment of fracture risk undertaken. Those vertebrae at his risk would then receive special implant to support the weakened bone and prevent fracture. This implant would only require key-hole surgery and would not impinge on the patient's quality of life through a lengthy recuperation period or additional pain. The research proposed responds to the Cancer Strategy in the NHS Long Term Plan and the EU's Beating Cancer Plan.Three Universities in the UK, University of Leeds, Imperial College and University College London, have come together to deliver this research so as to make a big change in the way these patients are treated. In addition we have formed an international network of academic, industrial and clinical collaborators from Europe, USA and Australia (OncoEng+ Network) with a focus on novel modelling, imaging, advanced materials and innovative medical devices to overcome the challenges of predicting fracture and producing a new implant. Impacts from the research include (1) new diagnostic tools for predicting bone failure using imaging and advanced computational modelling, which can be used in this and other disease such as osteoporosis, (2) a new patient-specific implant that can be inserted using minimally invasive surgery reducing the trauma to the patient and having a shorter recovery period (days rather than weeks or months); the implant would be inserted before the vertebrae is susceptible to fracture, (3) new manufacturing techniques for the delivery of the minimally invasive implant, which have wide ranging applications outside medicine including the aerospace and automotive sector, and (4) new test methodologies for spinal implants to ensure that these devices are tested under a range of activities including adverse conditions such as high patient loading. Importantly, the programme grant will train and up-skill a new generation engineers and scientists in a novel area of application-based research, that of devices for skeletal cancers and software for fracture prediction, and aims to bring together activities in the UK and internationally to form a holistic integrated activity.