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

在英国，大约有200万人患有癌症，这一数字将在未来十年内大幅上升至320万。晚期（第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体内不同部位引起的。转移与乳腺癌特别相关，乳腺癌是女性中最常见的癌症，也是该群体癌症死亡的主要原因。数字各不相同，但一些研究表明，约50- 60%的患者在晚期癌症中会发生骨转移。肿瘤削弱了骨骼，并在生活质量是首要考虑因素的时候为患者带来各种问题，特别是因为预后通常是晚期。严重的问题包括严重的疼痛和导致脊髓损伤的脊柱骨折。这些并发症通常需要进行大手术，这严重影响了患者的生活质量，而患者的预期寿命只有几个月，并且在某些情况下，可能会提供癌症进一步扩散的机制。目前，没有植入物在骨折前支撑骨骼，因为我们无法确定哪些椎骨可能会失败。OncoEng将在当前治疗技术和基于核心使能工程技术的应用的护理分层中实现范式转变。在OncoEng中实现了一种对患者更友好的方法，其中我们预测哪些患有肿瘤的椎骨将来可能会失败，从而能够做出明智的护理决策。先进的计算建模和成像将用于观察肿瘤的生长，以便可以在不同的时间点计算椎骨强度的预测。然后将这些强度与脊柱载荷进行比较，并评估骨折风险。那些有危险的椎骨将接受特殊的植入物来支撑脆弱的骨头，防止骨折。这种植入物只需要进行锁孔手术，不会因漫长的康复期或额外的疼痛而影响患者的生活质量。这项研究是对英国国民保健服务长期计划中的癌症战略和欧盟的战胜癌症计划的回应。英国的三所大学，利兹大学，帝国理工学院和伦敦大学学院，共同致力于这项研究，以使这些患者的治疗方式发生重大变化。此外，我们还建立了一个由来自欧洲、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），专注于新型建模、成像、先进材料和创新医疗器械，以克服预测骨折和生产新植入物的挑战。该研究的影响包括：（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）可以使用微创手术插入的新患者特定植入物，减少对患者的创伤并缩短恢复期（几天而不是几周或几个月）;植入物将在椎骨易于断裂之前插入，（3）用于递送微创植入物的新制造技术，其在医学之外具有广泛的应用，包括航空航天和汽车领域，以及（4）用于脊柱植入物的新的测试方法，以确保这些装置在一系列活动下进行测试，包括不利条件，例如高患者负荷。重要的是，该计划赠款将在基于应用的研究的新领域，即骨骼癌症设备和骨折预测软件领域，培训和提高新一代工程师和科学家的技能，并旨在将英国和国际上的活动汇集在一起，形成一个整体的综合活动。

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.