Advertisement

Smart Knife Detects Cancer Cells During Tumor Surgery

An “intelligent knife” that can immediately determine whether tissue is healthy or cancerous was 100% accurate in the first study to test the device in the operating room. Known as the iKnife, the innovative tool combines electrosurgery with rapid evaporative ionization mass spectrometry. The device draws surgical smoke—created by electrosurgical knives used to cut and cauterize blood vessels—into a mass spectrometer, which indicates if the cut tissue is cancerous or healthy. The iKnife can also distinguish normal and tumor tissues from different organs as well as identify the origin of the tumor that was a metastasis. Typically during cancer surgery, if a surgeon is unsure where the margins of the tumor are, tissue samples are sent to a pathologist for testing. This process can take 20 to 30 minutes and may require additional tissue. With only a 1- to 3-second delay for an iKnife readout, the feedback could minimize the time a patient is under anesthesia and allow surgeons to work faster and more effectively. The next clinical trial with the iKnife will determine if using the device will help reduce the number of recurring tumors and increase life expectancy....
Extending Survival After Inoperable Pancreatic Cancer

Extending Survival After Inoperable Pancreatic Cancer

Surgical resection of adenocarcinoma can significantly improve survival, but only 20% of patients are candidates to undergo this treatment. Typically, patients with unresectable pancreatic adenocarcinoma receive palliative, non-curative therapy. Recent research, however, suggests that accurate radiographic restaging, multimodality treatment, and advanced surgical technique can offer patients who have been previously deemed unresectable the possibility for curative salvage pancreatectomy. A New Approach for Pancreatic Cancer In the Journal of the American College of Surgeons, my colleagues and I at MD Anderson reported results from a study cohort of 88 high-risk patients who had been informed that their tumors were inoperable after an initial surgical attempt at removal. Of these patients, 66 completed a multidisciplinary treatment protocol with successful tumor removal. Risk for metastatic disease was stratified based on tumor involvement with local blood vessels, biopsy results and the nature of the tumor, and overall health status aside from pancreatic cancer. Patients who met these criteria underwent the MD Anderson protocol, which involved the following: A collaborative interpretation of pancreas-specific CT scans by surgeons and radiologists. Carefully administered preoperative chemotherapy and radiation treatment with multidisciplinary restaging prior to surgery. Use of advanced surgical techniques with planned removal and vascular reconstruction of involved blood vessels near the tumor. Using this protocol, we achieved survival numbers that are comparable to those of patients receiving surgery for clearly operable tumors. On average, patients undergoing the MD Anderson protocol lived about 30 months after tumor removal, which is almost three times longer than the average survival of 11 months for patients who do not undergo tumor resection. Key Considerations: Patient Selection & Imaging Our findings...

Surgery Beneficial for Benign Meningiomas

For patients with benign intracranial meningio­mas, single-fraction stereotactic radiosurgery appears to provide a high rate of tumor control. A ret­rospective review of 416 patients who underwent the procedure found disease-specific survival rates of 97% at 5 years and 94% at 10 years. The local tumor con­trol rates were 96% at 5 years and 89% at 10 years. Negative risk factors for local tumor control included male gender, prior surgery, and tumors located in the parasagittal/falx/convexity regions. Abstract: Neurosurgery, September...

Guideline Adherence & Post-Mastectomy Radiation Use

Radiation therapy after mastectomy is not always necessary for women with low-risk breast cancer, but it is frequently recommended for high-risk breast cancers. For intermediate breast cancers, use of radiation therapy after surgery remains controversial. Following the publication of three landmark trials in the mid- 1990s showing that post-mastectomy radiation therapy decreases locoregional recurrence and improves survival in patients with high-risk breast cancer, rates of this type of radiation increased from 36.5% to 57.7% from 1996 to 1998 (Table 1). In the late 1990s, several major associations released treatment guidelines endorsing the use of post-mastectomy radiation therapy in this population, most notably the American Society of Clinical Oncology and the National Comprehensive Cancer Care Network. A New Analysis of Post-Mastectomy Radiation In the October 15, 2011 issue of Cancer, investigators sought to determine if the use of post-mastectomy radiation has increased since national guidelines have recommended this approach for high-risk breast cancer patients. Researchers analyzed data from the SEER-Medicare database on 38,332 women aged 66 or older who underwent mastectomy for invasive breast cancer between 1992 and 2005. “Our study found that about 55% of women with high-risk breast cancer were receiving post-mastectomy radiation therapy,” says Benjamin D. Smith, MD, lead author of the analysis. “That is substantially lower than what we had anticipated.” “About 55% of women with high-risk breast cancer were receiving post-mastectomy radiation therapy. That is substantially lower than what we had anticipated.” Dr. Smith says that the rate of radiation therapy when indicated following lumpectomy is about 90%. “It’s paradoxical,” he adds. “Although radiation after lumpectomy has been shown to lower risk of cancer recurrence...
[ HIDE/SHOW ]