Three-minute surgery

By JEFF WEBER • GANNETT NJ • August 3, 2010

Dr. Shabbar Danish, the director of stereotactic and functional neurosurgery and an assistant professor at Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital, and his team perform laser-assisted thermal ablation surgery on Susanna Denude’s rare brain tumor on July 6.

Robert Wood Johnson University Hospital in New Brunswick has become the first hospital in the country to perform laser-assisted surgery on an intracranial ependymoma, a tumor that grows from the cells that line the ventricles in the brain.

Dr. Shabbar F. Danish and his neuroscience team successfully completed this surgery on Susanna Denude of Riverdale on July 6 in just three minutes — and Denude was awake the entire time. She even was in and out of the hospital in 24 hours.

“This is a tool for patients with tumors who have been told they do not have other options,” said Danish, the director of stereotactic and functional neurosurgery and an assistant professor at Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital. “I felt that she was a good candidate for this based on what her tumor looked like.”

Denude’s tumor had been around since 2003, when she underwent the first of two open craniotomies (the second was in September 2009) and endured a full dose of radiation. But those conventional methods did not stop the tumor’s growth.

Denude came to Danish in early June for a screening MRI, and once Danish saw what was going on, he approached the Denude and her husband, John, about the laser surgery, known as a complete thermal ablation.

“Thirty seconds into his presentation, we decided this is what we were doing,” John said. “We understood what was going to take place, and we knew this was right.”

How it works

The technique involves placing the laser directly into the tumor and then guiding the laser to perform the thermal ablation, which kills the tumor with heat while leaving the surrounding areas of the brain untouched.

The entry hole that is made through the skull is about the size of the end of a pen and requires just one stitch and a small bandage following the procedure. Denude was alert, talking and free of pain throughout the operation.

“In order to find the exact spot where the tumor is located, we use a GPS system for the brain so that we can identify the exact target location during laser placement, load and then map out a path in the operating room,” said Danish, who estimates that only 5 percent to 8 percent of brain tumors are intracranial ependymomas.

After the laser is placed in the brain, the patient is moved to an MRI unit, where the operating team can observe in real time how the brain changes temperature with respect to the laser.

“It uses a light energy in order to deliver the thermal therapy,” Danish said. “During the surgery, we could watch everything that was going on, and I was able to talk to her. She’s been under close observation to see what happens with the tumor over time, and so far, everything looks perfect.”

Not available to everyone

Many brain surgery patients are terrified of their pending operations. Denude handled it with relative ease.

“At first I was a little skeptical, but after listening to Dr. Danish, I felt that it was right for me to do this,” said Denude, a schoolteacher. “I don’t remember anything bad about it. There was no pain at all.”

Denude is just glad she had this option available to her. Not everyone does. Only six locations in the country — Hackensack; Manhasset, N.Y.; New Haven, Conn.; Baylor, Texas; and Denver — have this kind of technology, a fact from which Danish and his team derive much pride.

“These options don’t exist where you think they would exist, in Manhattan or Philadelphia. They exist here,” Danish said. “We get offered the ability to use new toys all the time . . .

“What I saw was an opportunity to use this as a tool for patients who had run out of options,” he continued. “Mrs. Denude had a tumor that was growing — we were watching it grow — and we thought this would be a good option for her.”

Print copy of this article (PDF)
Source – CourierPostOnline.com

New Brunswick, NJ – A leading neurosurgeon has performed the nation’s first laser-assisted brain surgery for a specific type of resistant brain tumor using technology so advanced that the patient went home the next day.

Shabbar F. Danish, M.D., Director, Stereotactic and Functional Neurosurgery and Assistant Professor at UMDNJ-Robert Wood Johnson Medical School (RWJMS) and Robert Wood Johnson University Hospital (RWJUH), used the Visualase, Inc., laser-assisted thermal ablation technique to operate on a patient with a recurring brain tumor after two previous surgeries and radiation did not permanently destroy the growth.

The technology is the latest addition to RWJUH and RWJMS’s growing expertise in the division of neuroscience. Dr. Danish specializes in the latest in stereotactic neurosurgery, which involves targeting small areas in the brain with techniques used to treat everything from Parkinson’s disease to brain tumors.

Susanna Denude of Riverdale, N.J., was diagnosed with an intracranial ependymoma, a tumor that grows from the cells that line the ventricles in the brain. While only six hospitals in the country offer laser-assisted thermal ablation, this is the first time in the nation that the treatment was used for an intracranial ependymoma, explains Dr. Danish.

“This is a tool for patients with tumors who have been told they do not have other options,” Dr. Danish says about laser-assisted thermal ablation. “This is also a viable option for patients who do not want radiation therapy or general anesthesia. Additionally, we can take their hospital stay from four to seven days down to 24 hours.”

The technique involves placing a laser directly into the tumor and then guiding the laser to perform thermal ablation, or killing it with heat, while leaving the surrounding areas of the brain untouched. The entry hole that is made through the skull is about the size of the end of a pen and requires just one stitch and a small bandage following the procedure.

“In order to find the exact spot where the tumor is located, we use a GPS system for the brain so that we can identify the exact target location during laser placement, load and then map out a path in the operating room,” says Dr. Danish.

After the laser is placed in the brain, the patient is moved to an MRI unit, where the operating team can observe in real time how the brain changes temperature with respect to the laser. “It uses a light energy in order to deliver the thermal therapy,” adds Dr. Danish. Only local anesthesia is used and the patient is able to go home the day after surgery.

“What we hope for Ms. Denude is that she goes on now to live a full life,” Dr. Danish says. “She’s a very active woman.”

To learn more about RWJUH, please visit www.rwjuh.edu. For a referral to a physician affiliated with RWJUH, please call 1-888-MD-RWJUH. Follow us on Twitter at www.rwjuh.edu/twitter and Facebook at www.rwjuh.edu/facebook.

To learn more about UMDNJ-Robert Wood Johnson Medical School, visit rwjms.umdnj.edu. Find our fan page on Facebook and follow us on Twitter @UMDNJ_RWJMS.

Revolutionary Techniques in Neurosurgery:
A Q&A with Ravish Patwardhan, MD

Published Online: April 15, 2010 – 3:03:03 PM (CDT)
Ravish Patwardhan, MD, is the founder and director of the Comprehensive Neurosurgery Network (www.brainandspinecare.com), which “specializes in minimally invasive techniques for treating brain and spine problems.” Patwardhan has more than 12 years of experience in the neurosurgery industry and has published several peer reviewed studies on brain trauma, tumors, epilepsy, and spinal procedures. He is also a frequent speaker on the latest treatments and advances in brain and spinal surgeries.

What are the benefits of the Visualase laser probe technique, and do you believe it will become the standard for brain tumor eradication?

The best way to understand the Visualase laser system is to understand what it simplifies. Say a patient comes in with a brain tumor that is less than 2cm in diameter. While he or she is awake, a small area of the scalp is locally anesthetized, and a stab incision is made, with a small hole drilled in the precise trajectory to enter the middle of the tumor and run its length. The operating room portion ends here. The patient is transferred to the MRI suite, where the precise position is verified on MRI scan. Subsequently, the tumor is ablated in the MRI scanner, leaving a black hole where the tumor used to be. The probe is removed in the MRI scanner, and a previously placed stitch is tied, all while the patient is awake and responding, to ensure that no new problem has occurred. The entire procedure takes about an hour (5 minutes in the operating room and 45 minutes in the MRI suite).

The length of time of the procedure, avoidance of general anesthesia, shortened length of stay in the hospital (patients may go home the same day versus three days or more, following a typical craniotomy for tumor resection), reduced blood loss (a few drops), smaller incision size (stab incision), and subsequently less pain all result in a quicker recovery. Because this technology is so new, we’re learning more about it with each case. We learn about which tumors in which locations may or may not be amenable to treatment with laser ablation. Presently, though, laser ablation’s advantages appear to be its ability to treat deep brain tumors—which would destroy the brain if approached openly surgically—and to produce relatively instant results. This is opposed to waiting several weeks to see an MRI change for techniques like Gamma Knife.

John Theurer Cancer Center brings together leading neuro-oncology experts to present key trends

Oncologists from top cancer institutions provide overview on new neuro-oncology guidelines

HACKENSACK, N.J. (April 5, 2010) —John Theurer Cancer Center at Hackensack University Medical Center will bring together top neuro-oncologists from around the country a symposium to address new treatment updates and review management of complex cases across a broad array of neuro-oncology specialties.

The Sixth Annual Neuro-Oncology Symposium: Update of New Guidelines in Neuro-Oncology will take place on Friday, April 9. The program will feature neuro-oncology experts from leading cancer institutions, including M.D. Anderson Cancer Center, Memorial Sloan Kettering Cancer Center, Northwestern University Medical Center, and Arkansas Neuroscience Institute.

“John Theurer Cancer Center is dedicated to providing doctors and others in the medical community with the most up-to-date, innovative research in all fields of oncology, including neuro-oncology,” said Mark Pascal, M.D., Co- Chief, Neuro-Oncology, John Theurer Cancer Center. “For the sixth consecutive year, we are proud to bring together a group of highly esteemed oncologists to discuss the latest trends in our field.”

These neuro-oncology leaders will discuss an array of topics, including the latest in surgical techniques for complex intracranial meningiomas, quality of life measures for brain tumor patients, radiosurgery outcomes for benign and malignant spinal tumors and an update on exciting new cutting-edge treatments for glioblastoma.

Featured speakers include:

• Ossama Al-Mefty, M.D., F.A.C.S., Co-Director, Arkansas Neuroscience Institute
• Christina Meyers, Ph.D., A.B.P.P., Professor, Department of Neuro-Oncology and Leader, Section of Neuro-Psychology, M.D. Anderson Cancer Center
• Jeffrey Raizer, M.D., Associate Professor, Neuro-Oncology and Medical Director, Neuro-Oncology, Northwestern University Medical Center
• Yoshiya Yamada, M.D., Attending, Radiation Oncology, Memorial Sloan Kettering Cancer Center
• Mark Pascal, M.D., Co- Chief, Neuro-Oncology, John Theurer Cancer Center
• Viswanathan Rajaraman, M.D., Co-Chief, Neuro-Oncology, John Theurer Cancer Center

This symposium is part of John Theurer Cancer Center’s ongoing commitment to provide extraordinary care through research and innovation. The neuro-oncology division includes one of the largest neuro-radiology services in the tri-state area to detect brain tumors. They also participate in a number of clinical trials and invest in state-of-the-art technology to improve patient outcomes. Most recently, the neuro-oncology division became one of 20 cancer centers in the United States to offer MRI-guided laser interstitial thermal therapy (LITT). This highly-precise technology allows physicians to destroy only the targeted tissue, leaving healthy surrounding tissues unharmed.

“As we continue to grow, we are committed to adopting new innovations to enhance our neuro-oncology division, ultimately prolonging survival time while improving quality of life,” said Viswanathan Rajaraman, M.D., Co-Chief, Neuro-Oncology, John Theurer Cancer Center.

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This conference is open to the public, but primarily for neuro and medical oncologists, neurologists, neurosurgeons, radiation therapists, neuro-radiologists and primary care physicians as well as other healthcare professionals involved in the treatment of brain and spinal tumor patients. The conference will be held from 7:30 am to 1:00 pm in the Hekemian Conference Center Auditorium located at Hackensack University Medical Center, 30 Prospect Ave., Hackensack, New Jersey. If you’re interested in attending please contact Bonnie LoGiudice at 201-996-4891 or blogiudiace@humed.com.

About John Theurer Cancer Center at Hackensack University Medical Center

John Theurer Cancer Center at Hackensack University Medical Center is New Jersey’s largest and most comprehensive center dedicated to the diagnosis, treatment, management, research, screenings, and preventive care as well as survivorship of patients with all types of cancer. The 15 specialized divisions covering the complete spectrum of cancer care have developed a close-knit team of medical, research, nursing, and support staff with specialized expertise that translates into more advanced, focused care for all patients. Each year, more people in the New Jersey/New York metropolitan area turn to the John Theurer Cancer Center for cancer care than to any other facility in New Jersey. Housed within a 775-bed not-for-profit teaching, tertiary care, and research hospital, John Theurer Cancer Center provides state-of-the-art technological advances, compassionate care, research innovations, medical expertise, and a full range of after care services that distinguish John Theurer Cancer Center from other facilities.

Real-Time Magnetic Resonance Imaging–Guided Focal Laser Therapy in Patients with Low-Risk Prostate Cancer

Excerpts below:

Abstract

Two patients with low-risk prostate cancer (PCa) were treated with outpatient in-bore magnetic resonance imaging (MRI)–guided focal laser ablation.

The tumor was identified on MRI. A laser fiber was delivered via a catheter inserted through a perineal template and guided to the target with MRI. The tissue temperature was monitored during laser ablation by MRI thermometry. Accumulated thermal damage was calculated in real time. Immediate post-treatment contrast-enhanced MRI confirmed devascularization of the target. No adverse events were noted. MRI-guided focal laser therapy of low-risk PCa is feasible and may offer a good balance between cancer control and side effects.

Once the catheter reached its target, the metal trocar was replaced by an optical fiber with a 1-cm-long cylindrically diffusing tip attached to a 980-nm diode laser (Visualase Inc, Houston, TX, USA).

During laser ablation, temperature was measured simultaneously on five 3-mm-thick image slices that covered the target volume (Fig. 5a). The thermometry scan was repeated every 6 s.

Fig. 5 (a) Tissue temperature map measured by magnetic resonance thermometry (echo planar imaging with multiphase; field of view: 25 × 25 cm; matrix 256 × 256; number of excitations: 1; repetition time: 545 ms; echo time: 20 ms; flip angle: 20°; slice thickness: 3 mm) during laser ablation; (b) a map of the tissue volume exceeding the threshold damage for coagulation was superimposed on the anatomical image, with the pink line measuring the maximum diameter of the ablated tissue.

The MRI thermometry software (Visualase, Inc, Houston, TX, USA) allowed us to monitor temperature at specific points in the tissue. The temperature at those points was used as a feedback to control the laser. During the laser heating, the temperatures at the border of the rectal wall and urethra were monitored and maintained at safe levels by shutting down the laser automatically when the temperature at these critical points exceeded 45 °C. Thermal damage was calculated using an Arrhenius formula. Temperature and damage maps were superimposed onto anatomic images (Fig. 5b). Once the desired volume of tissue destruction was achieved, laser power was stopped.

The patients were discharged home within 3 h. MR scans performed 2 wk post-treatment showed no evidence of complications with preservation of rectum and neurovascular bundles. No adverse effects were noted at ≤1 mo after treatment. Six-month follow-up biopsies are pending.

Outpatient MRI-guided FLT as used in the present study allows for visualization of the tumor; real-time guidance of the thermal device to the target; monitoring and control of the zone of ablation and surrounding tissue during treatment; and the ability to immediately confirm the success of the treatment and, if necessary, immediately repeat therapy. The required skills are common to other minimally invasive procedures, resulting in a short learning curve for the surgeon. Refinement of this outpatient procedure may result in an inexpensive, minimally invasive alternative to current active therapies. Further trials will be necessary to define the safety and oncologic efficacy of this therapy, but our early results are promising.

Acknowledgment

The authors would like to thank Drs. Ashok Gowda and Roger McNichols of Visualase Inc., Houston, Texas, USA, for generously supplying the laser and magnetic resonance thermometry system and for their technical support of this study.

Read the full article case study.

Prostate Cancer Research Projects

University of Chicago

Dr. Scott Eggener

“A Study to Evaluate Magnetic Resonance Thermal Image-guided Laser-Induced Thermal Therapy for Pinpoint destruction of Prostate Cancer.”

This human clinical trial, approved by the FDA, will test a treatment that can eliminate prostate cancer cells without damaging the surrounding tissues. The research team will evaluate the feasibility of a FDA-approved thermal therapy and feedback system (Visualase® Thermal Therapy System) for the treatment of biopsy confirmed and MR-imageable prostate lesions. This system has been used in humans for the treatment of brain, spine,thyroid, and liver cancers; however it has not yet been evaluated for the primary treatment of prostate cancer.

This system allows delivery of laser energy while the patient is simultaneously being imaged by an MRI unit. The system’s real-time MR thermal imaging (MRTI) provides information on the thermal dose delivered to the target, resulting in a more precise and controlled delivery which has not been possible with other cancer removal therapies. The researchers hypothesize the system can be a practical and feasible treatment for low-risk localized prostate cancer and allow patients to avoid the complications associated with radical whole-gland therapy. This clinical trial will take up to 2 years. PFC Funding Partners-The Longest Day of Golf Chicago and the University of Chicago Foundation.

New surgical technique uses laser energy to destroy brain tumors

Novel approach is minimally invasive and precise
04:20 PM CDT on Wednesday, October 7, 2009
Wendy Rigby / KENS 5

Perez has had one surgery to remove the tumor, but now the cancer has returned. This time, Dr. John Floyd, a U.T. Health Science Center neurosurgeon, is trying something different.

In an operating room at St. Luke’s Baptist Hospital, the doctor secured an anchor in the outside of the skull. Then, using what’s called neuro-navigation for precision, he slid a catheter several inches inside the head. That catheter houses a laser that can zap the cells growing out of control and threatening Perez’ life.

After the catheter was in place, the patient was moved to an MRI suite, where real-time images showed the doctors the area they were treating.

“Now we have another surgical technique which is minimally invasive and excellent for recurrences,” Floyd said.

While the two-step procedure took several hours, the heating and killing of the tumor took less than five minutes.

“In fighting brain cancer and brain tumors, we need everything that’s available at our disposal to be able to win the battle,” commented Dr. David Jimenez, head of the neurosurgery department at UTHSC.

Full article and video at News5

Visualase will be holding a seminar for physicians interested in the Visualase technology. Neurosurgeons that have used Visualase will present case studies and will be available for QnA. Please RSVP if you like to attend. There is limited capacity for this event.

Ray Turner, 33, a Medical University of South Carolina neurosurgeon, performed the first laser brain surgery in the hospital’s history, only the 10th performed in the United States and the 30th in the world. “It’s exhilarating,” he said Thursday. “This is what we want to do in medicine, stay on the cutting edge.”

Rare laser brain surgery a first at MUSC – The Post And Courier Charleston, SC

30 Minute Brain Surgery – WCIV ABC News 4 Charleston, SC

Watching Tumors Die

Thursday, April 2, 2009
By Sarah Petrie

Above, from left: Kamran Ahrar, M.D., and R. Jason Stafford, Ph.D., discuss an upcoming spinal surgery that will use the Visualase technology. They’ll be able to watch the tumor fully die in near real time during the procedure. Depending on where the tumor is located, the patient may or may not be awake during the procedure.

History books show that surgeons began removing cancerous tumors as early as the second century. Zoom ahead to 2009, take away the scalpels, scars and side effects that typically accompany surgery, and trade them for a tiny laser beam that zaps cancer dead on the spot. It sounds like science fiction, but our researchers and clinicians are among the first in the nation to investigate a new procedure that does just this … and more.

“It’s called laser-induced thermal therapy, and the basic theory is that the laser heats the tumor to a certain temperature to kill it,” explains Jeffrey Weinberg, M.D., associate professor in Neurosurgery, who’s conducting a clinical trial to test the effectiveness of this procedure on patients with metastatic brain tumors.
How hot is too hot for a cancerous tumor? Sixty degrees Celsius, in most cases.

“The clinical trial targets patients with otherwise inoperable tumors or those for whom other treatments failed,” Weinberg says. “This is possible because tissues surrounding the tumor aren’t harmed or affected with this procedure — an advantage over other types of brain surgeries for cancer, including radiosurgery.”

Delivering laser energy using a device only millimeters in diameter, the procedure leaves a scar no bigger than your thumb. Plus, there should be no side effects for this less-invasive surgery, which takes only a few hours from start to finish. “The laser portion should only take a few minutes, and patients will experience no swelling and little pain,” Weinberg adds.

Other forms of what also is known as ablation therapy already are in practice, killing tumors using heat, cold or electricity. So what makes this particular procedure so revolutionary? The physician actually watches the tumor die in real time, according to Kamran Ahrar, M.D., associate professor in Interventional Radiology, who has performed the procedure on a few patients with bone and spinal tumors as part of a similar clinical trial.

Weinberg agrees this is the biggest advantage of this method over other forms of treatment. “Patients don’t have to wait weeks or months for tests to confirm if the entire tumor is gone, as is the case with most surgeries. Instead, using this technology, we can convert magnetic resonance imaging into a color picture that indicates the temperature of the tissue,” he says. “This allows us to know exactly when the tumor is hot enough to fully die.”

How does it work?

Houston-based company Visualase Inc., which sells the technology, approached M. D. Anderson in 2000 for help with developing the tool. “For this procedure to be successful, the doctors must know the precise location and distribution of temperature in the tumor and that’s where the physicists come in the picture,” explains R. Jason Stafford, Ph.D., assistant professor in Imaging Physics, and lead consultant on the Visualase technology development for M. D. Anderson.

In other words, a stereotactic navigation system, “like a GPS for your brain” as Weinberg puts it, pinpoints the exact location and size of the tumor. After the surgeon drills a hole and sends the specially designed fiber directly to the tumor, the laser is activated, thus heating the tumor. Doing it in the MRI allows clinicians to monitor temperatures within the tissue. “Temperature as well as predicted regions of complete treatment are color-coded on a screen, giving us the ability to adjust or retreat a certain area, as needed,” Stafford adds.

And at M. D. Anderson, this entire procedure can be performed in one room, unlike at other institutions that also are researching the procedure. We have a dedicated intra-operative MRI suite, which is safer for patients than moving them to different locations to complete the procedure.

Burning out brain tumors: new procedure shows promise

Posted: Apr 20, 2009 5:59 PM CDT Updated: Apr 28, 2009 11:51 AM CDT
By Carolyn Roy, KSLA News 12

SHREVEPORT, LA (KSLA) – A Shreveport neurosurgeon has taken brain surgery for the removal of tumors to a whole new level, finding a way to obliterate a tumors, with much less risk.  A Many, Louisiana woman was the first patient in the U.S. to have the procedure done.

Karen Mowad … has been through surgery, chemotherapy and radiation…, but when the cancer spread to her brain, she came to Dr. Ravish Patwardhan of the Comprehensive Neurosurgery Network.

The Shreveport neurosurgeon had to open her skull to remove that tumor.  It’s the kind of surgery that leaves a big scar and comes with serious risks and a longer recovery time.  But by the time another tumor appeared last fall, Dr. Patwardhan had a new tool to try: a laser probe, and he was looking for a patient willing to be the first.  “We offered her both options,” says Dr. Patwardhan. “We said, ‘Look, you’ll be the first one in, really, North America to have this tumor re-sected for a metastatic brain tumor.  If you’re interested in it, we can do this. It involves making a small opening and going in and burning it.”  The alternative was another open operation.  Mowad was in.

The procedure, marries the precision of navigation tools … with an MRI-guided laser probe developed by Visualase out of Houston. “What this does is you just have to make a hole that will take you to the middle of the tumor, burn the tumor and then the tumor will essentially evaporate.  It’s actually done in the MRI suite, so when the probe is confirmed to be in the correct position in the MRI suite what you do then is heat it and you can watch it directly on the MRI scanner what area is being heated using the program.  After that you can do another MRI scan, since the patient is already there to show the tumor is gone.  So you have instant gratification.”

The procedure leaves behind a small pinpoint incision, comparable to that size of the tip of a pencil.  Karen Mowad was able to stay awake through the procedure, and felt no significant discomfort.  In addition to avoiding the risks related to anesthesia, the laser ablation probe is thin and slides through the brain with much less disturbance.  It allows the surgeon to reach even deep tumors with far less risk, like the brain swelling that comes with conventional procedures.

“It’s so much simpler and easier on the patient than a conventional procedure,” says Dr. Patwardhan.   It’s also faster, and it appears to be just as effective, if not more so.  Mowad’s surgery came at the end of one week.  She was back at work by the beginning of the next.  (Please note Visualase is effective in ablating tumors. It is not a cure for cancer.) Six months later, there is still no sign of the tumor.  “The number of people who make it out one year with a metastatic brain tumor is very low,” explains Dr. Patwardhan.  “She’s actually functioning and working, which is incredible.”

“It’s because of a lot of what I’ve been through, you know, I want other people not to be afraid of this.”

Since Mowad became the first patient in North America to undergo the procedure, several others have followed.  For now, Dr. Patwardhan says they’re reserving the laser treatment for brain tumors as a last resort, as long as patients’ conditions meet certain criteria.  “It’s restricted for tumors where you can go into them, which are tumors that are not extraordinarily hard, but there are quite a few tumors that are amenable to this treatment, so that’s nice.”

Click here to view the embedded video.

Click here to view the embedded video.

“Lasers used in keyhole surgery for brain cancer” – Agence France-Presse

Paris, France August 29th, 2008 – Visualase technology used to successfully treat brain tumors, as reported by AFP and the Telegraph (UK).

Read: AFP article | Telegraph article

Paris hospital hosts pioneering laser brain surgery

Saturday 30 August 2008 – A French team of neurosurgeons claims top have successfully tested a combination of new techniques, including fibre-optic lasers, in treating brain cancer through ultra-keyhole surgery.

Read: France24

Laser Ablation of Liver Metastases from Colorectal Cancer with MR Thermometry: 5-Year Survival

Purpose

To determine technical success, technique effectiveness, complications, and survival after laser ablation of liver metastases from colorectal cancer.

Materials and Methods

Eighty-seven consecutive patients (65 men and 22 women; mean age, 62.8 years) with 180 liver metastases from colorectal carcinoma were included between 1998 and 2005. They underwent laser ablation with magnetic resonance (MR) thermometry in 170 sessions. Indications for laser ablation were locally unresectable tumors (16.1%), metastases in both liver lobes (34.5%), and refusal of surgery and/or general contraindications to surgery (49.4%). Technical success, technique effectiveness, and complication and survival rates were evaluated retrospectively.

Results

Technical success was achieved in 178 of 180 sessions (99%). Follow-up after 24–48 hours demonstrated an effectiveness rate of 85.6%. Local tumor progression rate was 10% after 6 months. Major complications included large pleural effusion, large subcapsular hematoma, abscess, large pneumothorax, pleuritis with fever, intrahepatic hemorrhage, and biloma. Mean survival from the time of diagnosis of the primary tumor was 50.6 months for all patients treated (95% CI, 44.9–56.3 months). Median survival time was 54 months and survival rates were 95.7% at 1 year, 86.2% at 2 years, 72.4% at 3 years, 50.1% at 4 years, and 33.4% at 5 years. The mean survival time after the first treatment was 31.1 months (95% CI, 26.9–35.3 months).

Conclusions

Laser ablation of liver metastases of colorectal cancer with MR thermometry appears safe and efficacious. Although the results are encouraging, direct comparison with other ablative modalities in a prospective clinical trial would be necessary to definitely show one modality is superior.

Source:
Journal of Vascular and Interventional Radiology, Volume 20, Issue 2, Pages 225-234 (February 2009)

Liver tumours treated effectively by MR-guided laser ablation

20 December 2005

Destruction of cancerous liver tissue by laser light guided by magnetic resonance (MR) imaging was found to be as effective as traditional surgery for some patients, in a large-scale, 12-year study in Germany.

In the largest study of its type with the longest follow-up, 839 patients at the University of Frankfurt in Germany received MR-guided laser-induced thermotherapy (LITT) for the treatment of liver tumours resulting from colorectal cancer. Between 1993 and 2005, the researchers treated 2,506 liver tumours and tracked survival rates to evaluate the long-term results of the procedure. The average survival rate from the date of diagnosis was 3.8 years, which compares favourably to survival rates after traditional surgery (approximately 1.5 to 5.0 years). The study was presented at the annual meeting of the Radiological Society of North America (RSNA).

In LITT, also known as laser ablation, laser light is used to destroy tumour tissue. According to the study’s lead author, Martin Mack, M.D., laser ablation has many advantages over other treatment methods.

“Traditional surgical resection has higher morbidity and mortality rates than laser ablation,” said Dr. Mack, an associate professor in the department of diagnostic and interventional radiology at the University of Frankfurt. “Laser treatment can be done on an outpatient basis under local anaesthesia. Typically, the patient stays only a couple of hours, instead of a couple of weeks in the hospital after surgical liver resection,” he said.

Laser ablation can be used to treat tumours that occur in both halves of the liver — often during the same treatment — which is practically impossible in a traditional surgery where typically only the left or right lobe is resected. If new tumours are found during follow-up exams, it is much easier to repeat laser treatment than to subject the patient to another open surgery.

Laser ablation also holds advantages over radiofrequency ablation, another minimally invasive method of treating liver tumours, because it can be applied to different parts of the liver simultaneously and can be used with MR guidance to provide the radiologist with an accurate image of the tumour for precise targeting throughout the procedure. Radiofrequency ablation can only treat one tumour at a time and cannot be used with continuous MR monitoring.

Dr. Mack believes that laser combined with MR guidance will have wide-ranging impact on the treatment of tumours throughout the body, and may one day replace traditional surgery as the gold standard of treatment.

“Many surgeons are already performing local ablation instead of resection, because they have already recognized the positive effect of local ablation,” he said. “I believe that minimally invasive tumour ablation together with chemotherapy will play the most important role in the treatment of tumours in the years to come.”

Source: MTB Europe – Technology For Healthcare