Steerable Laser Interstitial Thermotherapy (SLIT) Robot for Brain Tumor Therapy

项目总结/摘要 胶质母细胞瘤（GBM）是最普遍和最具挑战性的癌症之一。每年，近12，000个新的 在美国诊断出GBM病例，总的中位生存期仅为12至18个月。GBM很少 转移到其他器官;然而，GBM肿瘤没有有效的治疗方法。标准疗法， 手术结合辅助放疗和FDA批准的药物可以使中位生存期延长几个月 但不能防止GBM的复发。对于复发性GBM（rGBM），预后甚至更差。重复 手术通常不被推荐，因为患者在最初的治疗过程中已经经历了手术。 GBM，其他治疗方案的疗效非常有限。激光间质热疗（LITT）是一种 微创治疗rGBM的新兴技术。通过将一个细长的激光探针插入大脑 对于肿瘤，LITT可以使用激光辐射来消融肿瘤组织。然而，现有的LITT设备 其通常将激光探针的尖端设置在肿瘤的核心处不足以实现适形消融（即， 具有最大肿瘤覆盖和最小附带损伤的消融），特别是当肿瘤较大时， 不规则形状或多灶性。因此，为了实现适形消融并提高LITT的疗效，我们 提出了一种新颖的机器人，在脑肿瘤内的多个位置提供热辐射。我们将开发一个 一种新型的可操纵激光间质热疗（SLIT）机器人，具有细长的足迹和定制的 设计的柔性激光消融探头。我们将通过一个小的切口将SLIT引入到脑肿瘤的周围。 钻孔，在关键结构周围操作SLIT，并在计划的目标处进行消融 临床医生在磁共振成像（MRI）的指导下。新程序的所有方面都将 由临床医生使用术中MRI和测温（MRT）进行远程监测和控制，以确保 精确性和安全性。在本计画中，我们将：1）设计并开发一个MR相容的可操控机器人， 柔性消融探针，2）开发能够规划和控制多部位肿瘤消融的软件，以及 3)使用临床相关模型评价SLIT的安全性和功能性。我们形成了 多学科团队，在微创手术机器人，生物医学光纤激光器， 神经外科、神经外科器械、神经病理学、高级MR成像、动物模型和 神经放射学，以成功地进行拟议的研究。用于rGBM治疗的LITT将作为以下研究的模型： 技术开发，而成果将产生一个变革性的平台， 神经外科手术，需要灵巧的微创进入脑病变。

Project Summary/Abstract Glioblastoma (GBM) is one of the most prevalent and challenging cancers to cure. Each year, nearly 12,000 new cases of GBM are diagnosed in the US, with the overall median survival being only 12 to 18 months. GBM rarely metastasizes to other organs; however, there is no effective treatment for GBM tumors. Standard therapies with surgery combined with adjuvant radiation and FDA-approved drugs can add a few months to median survival but cannot prevent the recurrence of GBM. For recurrent GBM (rGBM), prognosis is even more dismal. Repeated surgery is often not recommended since patients have already gone through it during the treatment of initial GBM, and the efficacy of other treatment options is very limited. Laser interstitial thermotherapy (LITT) is an emerging technique for minimally invasive treatment of rGBM. By introducing a slender laser probe into a brain tumor, LITT can ablate the tumor tissue percutaneously using laser radiation. However, existing LITT devices which often set the tip of a laser probe at the core of the tumor are inadequate to achieve conformal ablation (i.e., ablation with the maximum tumor coverage and minimum collateral damage), especially when tumors are large, irregularly shaped, or multifocal. Hence, to achieve conformal ablation and improve the efficacy of LITT, we propose a novel robot to deliver thermal radiation at multiple locations inside a brain tumor. We will develop a novel steerable laser interstitial thermotherapy (SLIT) robot with a slender footprint and a custom- designed flexible laser ablation probe. We will introduce SLIT to the peripheral of a brain tumor through a small burr hole, manipulate SLIT around critical structures, and perform ablation at targets that are planned by clinicians under the guidance of magnetic resonance imaging (MRI). All aspects of new procedure will be remotely monitored and controlled by clinicians using intra-operative MRI and thermometry (MRT) to ensure precision and safety. In this project, we will 1) Design and develop an MR-compatible steerable robot with a flexible ablation probe, 2) Develop software that enables planning and control of multi-site tumor ablation, and 3) Evaluate the safety and functionality of SLIT using clinically relevant models. We have formed a multidisciplinary team with expertise in minimally invasive surgical robots, biomedical fiber lasers, neurosurgery, neurosurgical devices, neuropathology, advanced MR imaging, animal models, and neuroradiology to successfully conduct the proposed studies. LITT for rGBM therapy will serve as a model for technology development, while the outcome will generate a transformative platform with applications to many neurosurgical procedures that require dexterous minimally invasive access to brain lesions.