http://www.whitaker.org/news/duerk.html
MRI-Guided Cancer Surgery
ROSSLYN, Va., April 16, 1997---A year after doctors gave up on William Hines,
his kidney tumor is gone and his life is back to normal. Hines is one of
seven patients to undergo an experimental procedure that has brought magnetic
resonance imaging into the operating room.
Hines, mayor of North Canton, Ohio, took part in a Phase I clinical trail
being conducted at Case Western Reserve University under the direction of
Jonathan Lewin, M.D. It is a safety and feasibility study focusing on
patients with isolated kidney tumors smaller than a tennis ball and no other
hope.
In the procedure, Lewin inserts a probe resembling a hypodermic needle into
the patient’s abdomen. He guides the tip of the probe into the heart of the
tumor using magnetic resonance imaging (MRI) techniques designed in the
laboratory of biomedical engineer Jeffrey Duerk, Ph.D.
The probe emits radio waves that heat and kill tumor cells. Watching the MRI
video monitor, doctors can adjust the instrument to reach all parts of the
malignancy while avoiding healthy tissue. As the physicians work, they can
actually see the tumor die.
Hines' previous surgeries had sidelined him for weeks at a time. After
repeated trips to the operating room, doctors said there was nothing more
they could do. For the experimental procedure, he rested for one night in the
hospital and returned to work in two days.
Since then, six other patients have followed. Disease progression was stopped
in two patients and slowed in two others. A fifth continues to spawn new
tumors, which are being treated. The sixth and most recent patient is doing
well, but it is still early.
Duerk and Lewin are presenting their scientific methods and clinical results
this week at the Fifth Scientific Meeting and Exhibition of the International
Society for Magnetic Resonance in Medicine in Vancouver, British Columbia.
Lewin is encouraged by the early results because kidney cancer is so
devastating. Most patients cannot withstand surgery and do not benefit from
chemotherapy. They are usually given six months to live.
"So for these patients, we have set the clock back," Lewin said. "And they
can go back to work in a day or so with a minimum of discomfort."
Until recently, MRI was used only for diagnosis. Now doctors in a handful of
medical centers around the country are experimenting with the imaging
technology as a tool in the operating room.
The Case Western group, funded in part by a $736,000 Whitaker Foundation
grant, is apparently the first to use an MRI-guided radio-frequency probe to
destroy abdominal tumors.
"A handful of groups have looked at radio-frequency ablation for tumors,"
Lewin said. "For the most part, this has been done with ultrasound or CT to
place a probe in a patient using an amount of energy that is expected to
treat the tumor. Then they follow up with some kind of imaging to see if it
was successful.
"In our protocol, we can interactively vary the energy and position of the
probe with MRI guidance and monitor cell death as it happens," he said. "We
can also guard against damaging vital structures."
The procedure relies on a Siemens open MRI machine coupled with a
high-resolution, shielded LCD monitor. Duerk’s group has rewritten the
software that drives the machine so it can make images more rapidly. As a
result, the image acquisition rate has risen from one frame every two minutes
to one per second.
The addition of a three-camera array allows doctors to follow the precise
position of the radio-frequency probe in three-dimensional space. "We can
track the exact location of the tip of the probe and see what’s behind it as
well," Duerk said.
The group hopes to begin a Phase II clinical trial for efficacy as early as
next fall.
--
Contact: Frank Blanchard (703) 528-2430, fb@whitaker.org
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