Researchers in Spain have created the first cancer operation room with a novel navigator system in which they are pioneering a new intraoperative radiotherapy approach that they hope will improve outcomes for patients with cancer. This image-guided system incorporates high-definition screens to visualize the patient in three-dimensional images, and includes three video-monitoring cameras and a group of eight infrared cameras for real-time navigation of the surgery bed.
Researcher Javier Pascau, MD, professor in the Bioengineering and Aerospace Engineering Department at the Universidad Carlos III, Madrid, Spain, said information is sent to a planning system, which updates the position of the applicator over the computed axial tomography of the patient. This allows the oncologist to compare the current position and orientation of the applicator with the one previously planned. Dr. Pascau and his colleagues have recently published their findings analyzing the feasibility of combining intraoperative electron radiation therapy (IOERT) with a multicamera optical tracking system.1
This new system may be appropriate for all tumor types, but the researchers report that the most convincing results have been demonstrated in cancers of the digestive system and sarcomas. The Spanish team hopes it will cut treatment time and provide significant benefits to patients. The investigators report that IOERT coupled with updated laparoscopic oncologic surgical techniques make it possible to reduce the postoperative period from between 4 and 7 days to just 48 hours. They suggest that with this approach, women with premature or low-risk breast cancer, radiation therapy treatment and surgery can be completed in only 24 hours instead of a duration of 6 to 8 weeks, as is the case with conventional treatment.
Alan Katz, MD, a radiation oncologist at Flushing Radiation Oncology in Flushing, NY, said the system under evaluation in Madrid sounds promising and may help lower morbidity and mortality. “It can deliver a higher biological dose than with external beam radiotherapy, which should control more cancers. Also, the technique will limit dose to the surrounding tissues and should minimize toxicity,” Dr. Katz said in an interview with ChemotherapyAdvisor.com.
In addition to the IOERT multicamera tracking system in Spain, researchers in the Netherlands have been analyzing the use of fast, one-dimensional magnetic resonance imaging (MRI) pencil-beam navigators that provide direct MRI feedback, with the possibility of adapting radiation treatments to the actual tumor position.2 The possibility of organ tracking and breath-hold monitoring based on navigator guidance for the kidney suggested that pencil-beam navigators may be suitable for fast, accurate detection of water-air, water-fat, and air-fat boundaries. The tracking consistency was found to be within 0.5 mm for the phantom and within 1.5 mm for the kidney.
For now, researchers are hoping these new intraoperative radiotherapy applicator systems will provide significant patient benefits and improve survival rates. However, Dr. Katz and other experts in this area said there are considerable costs associated with these new systems and future studies will need to demonstrate that the benefits to clinical outcomes outweigh the expense.
- García-Vázquez V, Marinetto E, Santos-Miranda JA, et al. Feasibility of integrating a multi-camera optical tracking system in intra-operative electron radiation therapy scenario. Phys Med Biol. 2013;58(24):8769-8782.
- Stam MK, Crijns SPM, Zonnenberg BA, et al. Navigators for motion detection during real-time MRI-guided radiotherapy. Phys Med Biol. 2012;57(21):6797-6805.