First Cancer Operation Room with Navigator Created

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A group of researchers from Gregorio Marañón Hospital, the company GMV and the Universidad Carlos III de Madrid (UC3M) have launched the very first cancer operation room equipped with a navigator, thus enabling an increased intraoperative radiotherapy safety.

The image-guided system, displayed at Gregorio Marañón Hospital, authorizes real-time interaction with the body of the patient (with its different tissues and cancer) in addition to the radiotherapy applicator used to radiate the tumor site. This advancement will be employed in the surgery of cancers treated with intraoperative radiotherapy in the promise of achieving greater precision and accuracy in the radiation of potentially cancerous tissues following the excision of the tumor.

The installation of this new equipment has involved a total restructuring of the operating room. The new room, reinforced for this kind of procedure, integrates high-definition screens of high diagnostic quality to visualize the image of the patient in 3-D, three video monitoring cameras and a cohort of eight infrared cameras for real-time navigation positioned in the area of the surgery that allows the surgeon to capture the movement of objects throughout the whole process. This technology shares the same values of movement capture that are used in cinema and in video games to transfer the movement of actors to animated characters.

Physicians will now have a 3-D illustration of the patient and the applicator that performs the radiation so that it can be guided into the patient through the high-definition screens set in the operating room.

The placement of the applicator over the tumor bed is observed so that only tissues with cancerous remnants or are at risk of turning cancerous is predetermined in each patient and are consequently radiated. Moreover, the area, the depth and the dose that any tissue such as skin, bone, muscle, intestines or bladder will receive can be predetermined and adjusted on-site and healthy tissues can be checked for any additional risk.

This device, constructed by scientists within the skeleton of research projects funded by the Autonomous Region of Madrid, the Ministry of Economy and Competitiveness and FEDER funds, makes the Madrid hospital an international point of reference in technological innovation and the application of research results to daily clinical practice.

Dr. Javier Pascau, professor in the Bioengineering and Aerospace Engineering Department at the UC3M and part of the BIIG research group led by Dr. Manuel Desco, is the head researcher of various research projects that include this development.

“The system employs multiple cameras to locate objects in three-dimensional scenarios like the intraoperative radiotherapy applicator. This information is sent to the planning system, which updates the real position of the applicator over the CAT (Computed Axial Tomography) of the patient and shows it on the screen. Thanks to this navigation system, the oncologist will be able to compare the current position and orientation of the applicator to the one previously planned and, if necessary, repeat the estimation of the distribution of the dose to adjust the treatment to the actual surgical scenario. The precision of the system, the first stereotactic navigator available in the field of intraoperative radiotherapy, has been evaluated by university researchers and was recently published in Physics in Medicine and Biology,” he explains.

Intraoperative radiotherapy is an anti-tumor treatment which, following the excision of the cancer, enables physicians to radiate the surrounding areas affected by the tumor or parts that could not be terminated with a high degree of accuracy.

Through this process, it is believed that the cancer then will not replicate. Additionally, "another advantage of this procedure is that all tumors can receive this treatment, although most of the ones that have been treated, and with very convincing results, were cancers of the digestive system and sarcomas," states head of the Oncology Department at Gregorio Marañón Hospital, Dr. Felipe Calvo.

Moreover, Calvo asserts that intelligent systems, like the intraoperative radiotherapy radiance simulator, developed and originated by Marañón Hospital researchers and practitioners and the company GMV, and this new navigator "will make it possible to cut treatment time thanks to the use of large single doses on a very well-defined tumor, protecting healthy tissue at the same time. Intraoperative radiotherapy does not compete with but instead complements chemotherapy and the administration of biological medicines."

Intraoperative radiotherapy has been integrated into improvements in laparoscopic oncological surgery with clear benefits for the patient, such as the reduction of the biological affect of the postoperative period from between 4 and 7 days to 48 hours, and a procedure which requires less invasive surgery. In premature breast cancer, instead of lasting six to eight weeks in the case of standard treatment, radiation therapy treatment and surgery can be done in only 24 hours.


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