Stephen C. Kanick, PhD and David W. Roberts, MD (DHMC Neurosurgery) are co-PIs on a 2015 SYNERGY Translational Pilot Grant entitled “Multiplexed Quantitative Assessment of Fluorescence Guided Neurosurgery.”
Neurosurgeons use fluorescent markers to provide visualization of important functional features of the brain. Some markers can be used to identify differences in tissue metabolic activity, and other tracers can identify leaky blood vessels that are associated with tumors. While most fluorescence guided surgery approaches rely on the eye of the surgeon to identify fluorescence light emitted by a single tracer, we are developing advanced optical approaches to independently estimate multiple fluorescence tracers. These approaches also provide measurements of the absolute value of the tracer concentration without distortions from blood absorption or tissue scattering within the surgical field. This SYNERGY grant focuses on the pilot clinical translation of a fiber optic approach to measure multiple fluorescent tracers during tumor resection surgeries.
Dartmouth SYNERGY works to speed the impact of discovery and translate new knowledge into practice and improved population health. By connecting to critical resources, funding opportunities, technologies, research training, and expertise, SYNERGY helps investigators advance research and efficiently translate discoveries into improved population health.
The SYNERGY Translational Pilot Program facilitates collaborative translational research studies across Dartmouth and affiliated health centers and communities. Pilot funding is intended to stimulate translational innovation, with a positive impact upon our overall clinical and translational research enterprise. The Translational Pilot Program systematically identifies, reviews, and selects novel multi- and interdisciplinary research concepts that have maximal potential for translation into patient care and population health. Dartmouth SYNERGY Clinical and Translational Science Institute is funded through the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program. The CTSA program is led by the NIH’s National Center for Advancing Translational Sciences (NCATS).
Dartmouth and Harvard researchers have been working on advances in photodynamic therapy for the past decade, and a program project grant to advance molecular strategies to enhance this with image guidance has been funded by the National Cancer Institute. This multidisciplinary grant aims to improve the treatment outcomes for two important groups of cancers – pancreatic cancer and non-melanoma skin cancer – by using new combination treatment regimens that incorporate photodynamic therapy (PDT) with novel imaging technologies.
Pancreatic cancer is one of the most lethal cancers, typically presenting as locally advanced and metastatic disease, with very poor prognosis. Non-melanoma skin carcinomas, including squamous cell carcinoma and basal cell carcinoma, are the most prevalent of human cancers and are clinically significant due to the sheer number of skin lesions. Through this Program we will use PDT to induce potent local effects and will combine it with small molecules and advanced nanoconstructs that maximize delivery, sensitize the tumor to PDT response, and have the potential to reduce metastasis.
The Program will measurably improve several clinical outcomes: reduced mortality for pancreatic cancer and squamous cell carcinoma; reduced morbidity; and reductions in overall healthcare costs. In addition, the Program will make some fundamental mechanistic discoveries. We will achieve our program goals through leveraging prior Phase I clinical studies, new tools to accelerate clinical translation, and industry collaborations, in order to move novel PDT combinations into the clinic.
Together with its industry partner PerkinElmer, Dartmouth has received NIH funding for a proposal entitled “Optical Scatter Imaging System for Surgical Specimen Margin Assessment during Breast Conserving Surgery.”
Breast conserving surgery is done routinely but has a high rate of subsequent surgery when cancer is found in the margin of the tissue removed. In fact, approximately one third of all patients are recalled for a second tumor excision when either residual cancer or ductal carcinoma in situ (DCIS) are found on the specimen surface or within 1-2 mm of it following pathology analysis in the days after the initial procedure.
There is a need for an accurate surgeon-assist device that can determine if the resected tissue is clear of cancer at the margins. This problem has a direct solution, however, through optical technology optimized for widefield and volumetric scanning, coupled with computer-aided decision making. Dartmouth and PerkinElmer will combine wide-field optical scatter spectroscopic imaging with volumetric CT scanning of specimens in a package that integrates the substantial pre-clinical experience by the PerkinElmer team with the substantial prototyping and clinical specimen imaging work of the Dartmouth team.
The combined system will initially be completed followed by testing of training data sets on known tissue samples from the breast lesion tissue bank. Following validation, a prospective trial will be carried out on the system to help determine the accuracy in margin identification. Taken together this will be one of the first comprehensive approaches to volumetric and surface scanning in a single package, and it comes from two groups with substantial experience in the aspects of cancer imaging and system development.
Optics in Medicine faculty & students have developed a new method of determining cancer stage and spread that is safer and potentially more accurate than conventional lymph node biopsy. The full technical report is published in the latest issue of Nature Medicine.
The report states, “Lymph node biopsy is employed in many cancer surgeries to identify metastatic disease and to determine cancer stage, yet morbidity and diagnostic delays associated with lymph node biopsy could be avoided if noninvasive imaging of nodal involvement were reliable.” This presents a new and improved method of noninvasive molecular imaging using a “dual-tracer” technique that corrects the problem of nonspecific uptake of imaging tracers that has made previous attempts at this approach clinically ineffective.
“This work summarizes the development of an imaging method that will allow oncologists to noninvasively detect microscopic levels of cancer spread to the lymphatic system in their patients,” says lead author Kenneth Tichauer, engineering professor at Illinois Institute of Technology and former Thayer School post-doc. “Cancer spread [metastasis] is the principal cause of mortality for cancer sufferers, and in an effort to characterize the metastatic potential of a patient’s disease, surgeons often remove tumor draining lymph nodes for analysis during surgical resection of the primary tumor. Such procedures can result in significant morbidity, yet the majority of lymph nodes are found to be free of cancer spread.” – See more at: Lymph Node Cancer Detection.
Robert Holt of the Department of Physics and Astronomy was awarded the Hannah Croasdale Award for 2014 at graduation! This award is given to the graduating PhD recipient from Dartmouth who best exemplifies the qualities of a scholar, supporting themselves and others around them. (see full story at the Graduate Forum)
A scientific breakthrough may give the field of radiation oncology new tools to increase the precision and safety of radiation treatment in cancer patients by helping doctors “see” the powerful beams of a linear accelerator as they enter or exit the body. Twelve patients are participating in a pilot study, which is being conducted by Thayer professor Brian Pogue, Geisel professors Lesley Jarvis and David J. Gladstone, graduate students Adam Glaser and Rongxiao Zhang, and medical student Whitney Hitchcock. While the Optics in Medicine Laboratory has been researching potential clinical applications of the Cherenkov effect for over four years, in July of 2013 the team first examined the fluorescent radiation in a female patient undergoing treatment for breast cancer. By integrating Cherenkov imaging into routine clinical care, the team believes that the technology could be used to verify that the proper dose is being delivered to patients, helping to avoid misadministration of radiation therapy, a rare, but dangerous occurrence.