Program 3

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Image Guided Local Treatment

Targeting macroscopic tumors in vivo : Image Guided Local Treatment

This research program is dedicated to cancer therapies that use physical agent to destroy the tumor: external radiation therapy and HIFU (High Intensity Focused Ultrasound). Radiotherapy uses high-energy photon beams and hadrontherapy uses charged particles (proton, carbon). HIFU treatments are non-invasive (no surgery) and radiation-free. Ultrasound waves are focused on the tumor to destroy it by thermal effect.

The aim of the program is to improve the available treatments to make them more efficient and targeted, and to also propose new therapies.

The program gathers researchers of 3 research units (CNRSInserm):

  • CREATIS for medical image analysis and processing
  • LabTAU for therapeutic application of ultrasound
  • EMR3738 for radiobology

Clinicians of the Centre Léon Bérard (Lyon Cancer Comprehensive Center)  and the Hospices Civils de Lyon (Lyon University Hospital) are also involved in this program:

  • ICE (Experimental Surgery Institute),
  • Radiotherapy department of the Centre Léon Bérard,
  • Department “urinary, vascular diagnostic and interventional radiology“ of the HCL.

This program is made of three tasks, each of with 3 stages: basic research, transfer research and clinical research.

The first task is dedicated to HIFU treatments.
A first medical device (MFOCUS) has been developed for the HIFU intraoperative treatment of the liver metastasis. This HIFU device can treat metastasis up to 2cm diameter within 130 seconds. This device is currently at the clinical evaluation stage and the EDAP-TMS company starts the pre-industrialization phase of the product.

The goal of a current clinical trial is to prove the feasibility, the innocuousness and the ability of the HIFU treatment to treat metastasis. This project is conducted by the LabTAU, the Centre Léon Bérard and the EDAP-TMS company. This new HIFU treatment concept will be used for other abdominal applications, especially for pancreatic cancer. A preclinical study is in progress to demonstrate that HIFU treatment can homogeneously destruct tissues of the parenchyma upon contact with vessel walls. It would be a major progress for the care of patients to demonstrate this therapeutic possibility for pancreatic cancer.

Cancer targeted treatment is a major research topic of the scientific and medical community, and is well represented in the LYric. Development of reliable and reproducible techniques requires a precise localisation of the cancer targets. This could be hard, especially for some kind of cancer like the prostate cancer. In this case indeed, image guided localization and characterization of in-vivo targets represent a diagnosis challenge.

LabTAU and Creatis are associated to develop a computed-based diagnostic support system, based on machine-learning methods and multimodal imaging (MRI and ultrasound). The first phase of the project allows a first decision-making system to combine different type of MRI images. The second phase is under-development and intends to integrate the ultrasound imaging. The goal is to propose a guiding system for the HIFU system.

The second task focus on ionizing radiation, radiotherapy and hadrontherapy treatments. A project aims to clinically implement an alternative strategy for the treatment of advanced lung cancer. This strategy is based on deformable image registration algorithms that have been developed in our team since several years. For some patient, we hope that the proposed new treatment strategy may decrease the dose received by the healthy tissues near the tumor. The clinical trial named “midP” with 50 patients started in September 2012.

A second project aims to use US image to guide prostate treatment. This could allow reducing a part of the ballistic uncertainties and improving the treatment, without additional radiation due to x-ray imaging.

A third axis concerns radiobiology. It aims to determine the best combination of a panel of protein biomarkers for predicting the failure of a therapeutic strategy by photon-or carbon-therapy from the study of their expression on the pre-therapeutic tumor biopsy performed in a prospective cohort of 250 patients with non-metastatic sarcoma or adenoid cystic carcinoma.

The third “emerging” task, aims to develop an innovative and non-invasive HIFU treatment for liver tumor. By using previous preclinical studies on HIFU treatment of hepatic metastasis, we seek to develop an extracorporeal treatment procedure, without surgery and puncture-free. One application is the treatment of liver primary tumor (hepatocellular carcinoma). Ultrasound imaging will guide the HIFU probe and will allow to identify the treatment zone. As tumor is moving due to the respiratory motion, real-time guidance and HIFU waves control will be developed. A first HIFU device has been developed following this principle. Preliminary in-vitro trials confirmed that a complete non-invasive treatment of liver cancer is possible.

Figure ci-dessous :
(haut) scanner X de la zone hépatique, avec une segmentation simplifiée du foie.
(bas) guidage par échographie avec superposition des zones segmentées à l’image US.

prog3-scanner

Image Guided Local Treatment

This research program is dedicated to cancer therapies that use physical agent: external radiation therapy and HIFU (High Intensity Focused Ultrasound). HIFU treatment are non-invasive (no surgery) and radation-free.

The aim of the program is to improve the available treatment to bring them more efficient and targeted, and to also propose new therapies .

Clinicians of the Centre Léon Bérard (Lyon Cancer Comprehensive Center) and the Hospices Civils de Lyon (Lyon University Hospital) are involved in this program:

  • ICE (Experimental Surgery Institute),
  • Radiotherapy department of the Centre Leon Berard,
  • Department “urinary, vascular diagnostic and interventional radiology“ of the HCL.

This program is made of three main tasks; each of them consists of 3 stages : basic research, transfer research and clinical research.

The first task is dedicated to HIFU treatment.
A first medical device has been developed for treatment of liver metastasis. This HIFU device can treat metastasis up to 2cm diameter within 130 seconds. This device is currently at the clinical evaluation stage and the EDAP-TMS company starts the pre-industrialization phase of the product.
Several development of the device are currently being studied with the LYric, among them the use of HIFU for the pancreatic cancer.

Cancer targeted therapy is a major research focus of the scientific and medical community, and is well represented in the LYric. The LabTAU and the Laboratoire Creatis have developed a reliable support-diagnosis tool, to create a precise map of the cancer cells. In the end the goal is to produce a guiding system for the HIFU treatment.

The second task focus on ionizing radiation, radiation therapy or hadrontherapy treatment. In this context, a project aims to clinically implement an alternative strategy to treat the advanced lung cancer. This strategy may decrease for some patients the dose received by the healthy tissues near the tumor. A clinical trial with 50 patients started in September 2012.
Another tasks focus on prostate radiotherapy guiding with ultrasound imaging, or markers studies to determine if a radiotherapy or hardontherapy treatment will fail or succeed.

The third “emerging” task aims to develop an innovative and non-invasive HIFU treatment for liver tumor. The program seeks to create a treatment procedure without any surgery and puncture-free.  One application is the treatment of liver primary tumor (hepatocellular carcinoma).
Ultrasound imaging will guide the device and will allow identifying the treatment zone.
A first HIFU device has been developed following this principle. Preliminary in-vitro trials confirm that a complete non-invasive treatment of liver cancer is possible.