Laser Interstitial Thermal Therapy (LITT) in Neuro-Oncology. Tim Lucas, MD, PhD Neurosurgery

Size: px
Start display at page:

Download "Laser Interstitial Thermal Therapy (LITT) in Neuro-Oncology. Tim Lucas, MD, PhD Neurosurgery"

Transcription

1 Laser Interstitial Thermal Therapy (LITT) in Neuro-Oncology Tim Lucas, MD, PhD Neurosurgery 2016

2 Laser Interstitial Thermal Therapy (LITT) in Neuro-Oncology Tim Lucas, MD, PhD Neurosurgery 2016

3 Financial Disclosures None Lucas Lab Funding sources T32 3

4 Outline Laser ablation background Mechanism of action Indications Outcomes 4

5 Evolution of LITT Chu and Dupuy,

6 Mechanism of action 6

7 Tissue effects following LITT 1 d 1 w Schulze et al., Acta Neurochir (Wein)

8 Real-Time Imaging of Ablation Site 1 Site 2 8

9 Real-Time Imaging of Ablation 9

10 Post-Ablation 10

11 Neurosurgical Indications Radiation Necrosis Epileptic Focus Metastasis Glioma Deep-seated lesion Peri-eloquent lesion Lesion resistant to alternative treatment modality (Radiotherapy) Glioma cont Patient preference for minimally-invasive approach Salvage therapy for lesions having reached toxic threshold of other modalities Clinical contraindications for open craniotomy 11

12 LITT Outcomes in Neuro-oncology LITT treated patients Median Overall Survival Dx Median Overall Survival Recur Median Overall Survival LITT Progression Free Survival Recurrent III / IV (n=66) Metastasis (n=25) Radiation Necrosis (n=28) % at 5.7 mos* 66.7% at 3 mos 11.4 n/a n/a n/a Local Control n/a n/a 75.6%* *Rao et al., 2014 Data in months Banerjee et al.,

13 Neuro-oncology investigations 1 st Author Yr Lx N Size max (cm) Outcome (MOS from time of treatment) Sugiyama 1990 riv stable at 12/34 mon; 1 died at 23 mon Acher 1991 II 8 NR NR Roux 1992 II Progression Kahn 1994 II-IV II: no progression ; III: progression Leonardi 1999 II-IV 24 NR II: PFS 16 mon; III: 10 mon; IV: 4 mon Schulze 2004 III-IV 8 NR NR Schwarzrmaier 2006 riv 2 large MOS mon Carpentier 2012 riv PFS 1 mon; MOS 10 mon Jethwa 2012 Mixed* 20 4 NR Sloan 2013 riv MOS 11 mon Mohammadi 2014 IV-rIV 34 NR PFS 5.1 mon MOS median overall survival; PFS progression free survival 13

14 Complication Rate of conventional craniotomy for recurrent glioma Recurrent glioma presents surgical challenges, including: prior craniotomy, fractionated radiotherapy, chemotherapy, antiangiogenic therapy Second craniotomy risks Overall complication rate 27% vs. 12.8% (OR 2.52; p<0.01) Hoover et al., 2013 JNS Periop complications rate 33% vs. 24% (p<0.01) Neurological decline (18% vs. 8%; p<0.01) Systemic infection (4.4% vs. 0%; p<0.0001) Chang et al. (Glioma Outcomes Investigators), 2003 JNS N=788; 499 (open crani) 14

15 Conclusions LITT is a method of image-guided stereotactic ablation of brain lesions LITT is safe, with acceptable risk profile LITT complements existing treatment modalities LITT is growing in provider utilization and patient awareness Additional prospective investigation is needed to evaluate comparative effectiveness Timothy.Lucas@uphs.upenn.edu 15

16 16

17 Complications of LITT 1 st author (year) complication Bettag (1991) Edema at margin Leonardi (1999) Carpentier (2012) Transient neurological decline; superficial infection; focal seizure Transient dysphasia; CSF leak; seizure Jethwa (2012) Sloan (2013). Phase I dose escalation trial Vascular injury (craniotomy); malignant edema (craniotomy), inaccurate laser placement (craniotomy), DI secondary to pituitary injury Vascular injury; hemiparesis; hemianopia; dysphasia A word about Neuroblate vs. Visualase 17

18 LITT Potential advantages Minimal blood loss (~1cc) Early mobilization (9/10 within 12 hrs; neuroblate phase I trial) Option of multiple treatments spread out in time Short length of hospital stay 18

19 Tissue coagulation in brain tumor models Brown, Phototherapy in tumors. World J Surg 1983; 7(6):700-9 Brown, The future of lasers in cancer therapy. Br J Hosp Med 1988;40:161 Schulze et al., Effects of laser-induced thermotherapy (LITT) on proliferation and apoptosis of glioma cells in rat brain transplantation tumors. Lasers Surg Med 2002;30:

20 Laser methodology Nd:YAG neodymium-doped yttrium aluminum garnet laser (λ = 1,064 nm) Continuous wave CO2 laser Diode laser (λ = nm) Varying range of power Close to local water absorption, allowing faster lx and sharp thermal gradients. Dosed in joules/s (W) 20

21 Mechanism of action Thermal reaction proportional to power applied by laser. Photons absorbed by tumor chromophores causing excitation and release of thermal energy. Extrinsic properties such as wavelength and intrinsic properties such as absorption coefficients determine extent to thermal ablation Thermally induced tissue necrosis occurs above 43deg C. 21

22 Procedure Laser inserted stereotactically into target tissue Laser activated in MRI scanner Temperature Map Modeled in real-time Ablation discontinued when desired lesion created 22

23 Complications of craniotomy for recurrent glioma Chang et al. (Glioma Outcomes Investigators), 2003 JNS N=788 23

24 Complications of craniotomy for recurrent glioma Chang et al. (Glioma Outcomes Investigators), 2003 JNS N=788 24

25 Visualase laser The details PhoTex 15 laser Class IV 15W continuous wave 980 nm diode laser, and Class II 670 nm red aiming beam for service purposes. Laser diffusing element is encased in an armored 400 um silica optical fiber. Nominal ocular hazard distance is 2.7 m 25

26 FLAIR FLAIR T1+ preop d0 intraop 2 mon 5 mon 26

27 27

28 28

29 29

30 Willie, et al., NS 2014;74(6):569-30

31 Outcomes: Litt for recurrent III/IV lesions Median Overall Survival from diagnosis: 20.9 months Median Overall Survival from recurrence: 11.4 months Median Overall Survival from LITT: 9.9 months Median Progression Free Survival: 4.5 months Total moderate-to-severe complication rate: 21.2% Total severe complication rate: 16.7% 31

SYSTEM OVERVIEW MINIMALLY INVASIVE ROBOTIC LASER THERMOTHERAPY

SYSTEM OVERVIEW MINIMALLY INVASIVE ROBOTIC LASER THERMOTHERAPY SYSTEM OVERVIEW MINIMALLY INVASIVE ROBOTIC LASER THERMOTHERAPY Software NeuroBlate Fusion Software is the exclusive software intelligence behind the NeuroBlate System. NeuroBlate Fusion allows neurosurgeons

More information

NOW WITH SYSTEM OVERVIEW MINIMALLY INVASIVE ROBOTIC LASER THERMOTHERAPY

NOW WITH SYSTEM OVERVIEW MINIMALLY INVASIVE ROBOTIC LASER THERMOTHERAPY NOW WITH SYSTEM OVERVIEW MINIMALLY INVASIVE ROBOTIC LASER THERMOTHERAPY Mini-Bolt Access Robotically Controlled Probe Driver MRI-Guided Laser Energy PRECISION AND CONFIDENCE DELIVERED THROUGH A MINIMALLY

More information

Gliomas account for 28% of the nearly 70,000 primary

Gliomas account for 28% of the nearly 70,000 primary See the corresponding editorial in this issue (E2). Neurosurg Focus 37 (6):E1, 2014 AANS, 2014 Stereotactic laser ablation of high-grade gliomas Ammar H. Hawasli, M.D., Ph.D., 1 Albert H. Kim, M.D., Ph.D.,

More information

EPILEPSY 2018: UPDATE ON MODERN SURGICAL MANAGEMENT. Robert Kellogg, MD Advocate Children s Hospital Park Ridge, IL April 20, 2018

EPILEPSY 2018: UPDATE ON MODERN SURGICAL MANAGEMENT. Robert Kellogg, MD Advocate Children s Hospital Park Ridge, IL April 20, 2018 EPILEPSY 2018: UPDATE ON MODERN SURGICAL MANAGEMENT Robert Kellogg, MD Advocate Children s Hospital Park Ridge, IL April 20, 2018 No disclosures OBJECTIVES Brief history of epilepsy surgery Pre-operative

More information

Review Article Magnetic Resonance-Guided Laser Induced Thermal Therapy for Glioblastoma Multiforme: A Review

Review Article Magnetic Resonance-Guided Laser Induced Thermal Therapy for Glioblastoma Multiforme: A Review BioMed Research International, Article ID 761312, 9 pages http://dx.doi.org/10.1155/2014/761312 Review Article Magnetic Resonance-Guided Laser Induced Thermal Therapy for Glioblastoma Multiforme: A Review

More information

A Minimally Invasive Option for Patients Considering Brain Surgery

A Minimally Invasive Option for Patients Considering Brain Surgery PATIENT S GUIDE A Minimally Invasive Option for Patients Considering Brain Surgery MINIMALLY INVASIVE ROBOTIC LASER THERMOTHERAPY Robotically Controlled Probe Driver Precise nature of the NeuroBlate System

More information

Radiation Therapy for Liver Malignancies

Radiation Therapy for Liver Malignancies Outline Radiation Therapy for Liver Malignancies Albert J. Chang, M.D., Ph.D. Department of Radiation Oncology, UCSF March 23, 2014 Rationale for developing liver directed therapies Liver directed therapies

More information

Tania Kaprealian, M.D. Assistant Professor UCLA Department of Radiation Oncology August 22, 2015

Tania Kaprealian, M.D. Assistant Professor UCLA Department of Radiation Oncology August 22, 2015 Tania Kaprealian, M.D. Assistant Professor UCLA Department of Radiation Oncology August 22, 2015 Most common brain tumor, affecting 8.5-15% of cancer patients. Treatment options: Whole brain radiation

More information

PHOTOTHERAPY: WHAT DO WE KNOW AND HOW DOES IT WORK? Suite 3/36 O'Riordan Street Alexandria, Sydney NSW Australia

PHOTOTHERAPY: WHAT DO WE KNOW AND HOW DOES IT WORK? Suite 3/36 O'Riordan Street Alexandria, Sydney NSW Australia PHOTOTHERAPY: WHAT DO WE KNOW AND HOW DOES IT WORK? Suite 3/36 O'Riordan Street Alexandria, Sydney NSW Australia 2015 02 8331 8933 info@infinity-led.com.au DOCTORATE IN HEALTH SCIENCE DEAKIN UNIVERSITY

More information

Brain metastases: changing visions

Brain metastases: changing visions Brain metastases: changing visions Roberto Spiegelmann, MD Baiona, 2014 Head, Stereotactic Radiosurgery Unit Dept of Neurosurgery, Chaim Sheba Medical Center Tel Hashomer, Israel The best current estimate

More information

Collection of Recorded Radiotherapy Seminars

Collection of Recorded Radiotherapy Seminars IAEA Human Health Campus Collection of Recorded Radiotherapy Seminars http://humanhealth.iaea.org The Role of Radiosurgery in the Treatment of Gliomas Luis Souhami, MD Professor Department of Radiation

More information

Place of surgery in diagnos1c and therapeu1c strategies: New challenges

Place of surgery in diagnos1c and therapeu1c strategies: New challenges Place of surgery in diagnos1c and therapeu1c strategies: New challenges Philippe Métellus M.D., Ph.D. Department of Neurosurgery, CHU Timone, Marseille, France Place of surgery in diagnos1c and therapeu1c

More information

Magnetic Resonance guided Laser Interstitial Thermal Therapy for medically intractable epilepsy

Magnetic Resonance guided Laser Interstitial Thermal Therapy for medically intractable epilepsy Magnetic Resonance guided Laser Interstitial Thermal Therapy for medically intractable epilepsy Alexander G. Weil, MD, FRCSC, FAANS, FACS 1,2 1 Division of Pediatric Neurosurgery, Department of Surgery,

More information

Invasive Evaluation for Epilepsy Surgery Lesional Cases NO DISCLOSURES. Mr. Johnson. Seizures at 29 Years of Age. Dileep Nair, MD Juan Bulacio, MD

Invasive Evaluation for Epilepsy Surgery Lesional Cases NO DISCLOSURES. Mr. Johnson. Seizures at 29 Years of Age. Dileep Nair, MD Juan Bulacio, MD Invasive Evaluation for Epilepsy Surgery Lesional Cases NO DISCLOSURES Dileep Nair, MD Juan Bulacio, MD Mr. Johnson Seizures at 29 Years of Age Onset of seizures at 16 years of age bed wetting episodes

More information

Laser interstitial thermal therapy (LITT) is a minimally

Laser interstitial thermal therapy (LITT) is a minimally neurosurgical focus Neurosurg Focus 38 (3):E13, 2015 Renaissance of laser interstitial thermal ablation Symeon Missios, MD, 1 Kimon Bekelis, MD, 2 and Gene H. Barnett, MD, MBA 3 1 Department of Neurosurgery,

More information

SURGICAL MANAGEMENT OF BRAIN TUMORS

SURGICAL MANAGEMENT OF BRAIN TUMORS SURGICAL MANAGEMENT OF BRAIN TUMORS LIGIA TATARANU, MD, Ph D NEUROSURGICAL CLINIC, BAGDASAR ARSENI CLINICAL HOSPITAL BUCHAREST, ROMANIA SURGICAL INDICATIONS CONFIRMING HISTOLOGIC DIAGNOSIS REDUCING TUMOR

More information

Financial Disclosures

Financial Disclosures Retinoblastoma Management: Update Jesse L. Berry, MD Associate Director, Ocular Oncology Service Associate Program Director USC/CHLA, Keck School of Medicine Financial Disclosures Research Support: Bright

More information

Radiation Necrosis 11/29/2016. Disclosure statement. Memorial Sloan Kettering Cancer Center

Radiation Necrosis 11/29/2016. Disclosure statement. Memorial Sloan Kettering Cancer Center Radiation Necrosis Date: December 1 st, 2016 Wayne Quashie, MSN, CNS, ACNS-BC, AOCNS Clinical Nurse Specialist Neurology, Neurosurgery and Orthopedics www.mskcc.org Disclosure statement Presenter does

More information

Is it cost-effective to treat brain metastasis with advanced technology?

Is it cost-effective to treat brain metastasis with advanced technology? Is it cost-effective to treat brain metastasis with advanced technology? Cost-effectiveness analysis of whole brain RT, stereotactic radiosurgery and craniotomy in HA setting Lam, Tai-Chung, Choi CW Horace,

More information

Update on Pediatric Brain Tumors

Update on Pediatric Brain Tumors Update on Pediatric Brain Tumors David I. Sandberg, M.D. Director of Pediatric Neurosurgery & Associate Professor Dr. Marnie Rose Professorship in Pediatric Neurosurgery Pre-talk Questions for Audience

More information

MALIGNANT GLIOMAS: TREATMENT AND CHALLENGES

MALIGNANT GLIOMAS: TREATMENT AND CHALLENGES MALIGNANT GLIOMAS: TREATMENT AND CHALLENGES DISCLOSURE No conflicts of interest to disclose Patricia Bruns APRN, CNS Givens Brain Tumor Center Abbott Northwestern Hospital October 12, 2018 OBJECTIVES THEN

More information

Brain Tumors. Andrew J. Fabiano, MD FAANS. Associate Professor of Neurosurgery Roswell Park Cancer Institute SUNY at Buffalo School of Medicine

Brain Tumors. Andrew J. Fabiano, MD FAANS. Associate Professor of Neurosurgery Roswell Park Cancer Institute SUNY at Buffalo School of Medicine Brain Tumors Andrew J. Fabiano, MD FAANS Associate Professor of Neurosurgery Roswell Park Cancer Institute SUNY at Buffalo School of Medicine Brain Tumors Brain Tumor Basics Types of Tumors Cases Brain

More information

Clinical Trials for Adult Brain Tumors - the Imaging Perspective

Clinical Trials for Adult Brain Tumors - the Imaging Perspective Clinical Trials for Adult Brain Tumors - the Imaging Perspective Whitney B. Pope, M.D., Ph.D. Department of Radiology David Geffen School of Medicine at UCLA August 22, 2015 1 Disclosure of Financial Relationships

More information

Laser Ablation for Brain Tumors

Laser Ablation for Brain Tumors Laser Ablation for Brain Tumors Gene H Barnett, MD, MBA Department of Neurosurgery Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center Taussig Cancer and Neurological Institutes Cleveland Clinic

More information

Index. C Cancer, Carcinoid syndrome, 413. D DCIS. See Ductal carcinoma in situ (DCIS) DEB-TACE. See Drug eluting beads-tace (DEB-TACE)

Index. C Cancer, Carcinoid syndrome, 413. D DCIS. See Ductal carcinoma in situ (DCIS) DEB-TACE. See Drug eluting beads-tace (DEB-TACE) Index A Ablation, 179 199, 843 853 devices, 179, 199 liver tumors, 527 techniques, 516 Ablative radiation therapy, 456 Accelerated partial breast, 894, 896 898 Adaptive radiation therapy, 586, 598, 602

More information

11/27/2017. Modern Treatment of Meningiomas. Disclosures. Modern is Better? No disclosures relevant to this presentation

11/27/2017. Modern Treatment of Meningiomas. Disclosures. Modern is Better? No disclosures relevant to this presentation Modern Treatment of Meningiomas Michael A. Vogelbaum MD, PhD Professor of Neurosurgery Cleveland Clinic Disclosures No disclosures relevant to this presentation IP and royalties related to drug and device

More information

Epilepsy Surgery, Imaging, and Intraoperative Neuromonitoring: Surgical Perspective

Epilepsy Surgery, Imaging, and Intraoperative Neuromonitoring: Surgical Perspective Epilepsy Surgery, Imaging, and Intraoperative Neuromonitoring: Surgical Perspective AC Duhaime, M.D. Director, Pediatric Neurosurgery, Massachusetts General Hospital Professor, Neurosurgery, Harvard Medical

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM LOW GRADE GLIOMAS CNS Site Group Low Grade Gliomas Author: Dr. Norm Laperriere 1. INTRODUCTION 3 2. PREVENTION 3 3. SCREENING

More information

Hands-on: Lasers. NonAblative Rejuvenation

Hands-on: Lasers. NonAblative Rejuvenation Hands-on: Lasers NonAblative Rejuvenation Anthony M. Rossi, MD Assistant Attending Memorial Sloan Kettering Cancer Center Assistant Professor Weill Cornell Medical College DISCLOSURE OF RELEVANT RELATIONSHIPS

More information

Radiotherapy approaches to pituitary tumors

Radiotherapy approaches to pituitary tumors Disclosures No relevant disclosures Radiotherapy approaches to pituitary tumors Pituitary Disorders: Advances in Diagnosis and Management Steve Braunstein, MD, PhD UCSF Department of Radiation Oncology

More information

Diffusion Tensor Imaging in brain tumours

Diffusion Tensor Imaging in brain tumours Diffusion Tensor Imaging in brain tumours @MarionSmits, MD PhD Associate Professor of Neuroradiology Dept. of Radiology, Erasmus MC, Rotterdam (NL) Honorary Consultant and Reader UCLH National Hospital

More information

Neurosurgical Management of Brain Tumours. Nicholas Little Neurosurgeon RNSH

Neurosurgical Management of Brain Tumours. Nicholas Little Neurosurgeon RNSH Neurosurgical Management of Brain Tumours Nicholas Little Neurosurgeon RNSH General Most common tumours are metastatic 10x more common than primary Incidence of primary neoplasms is 20 per 100000 per year

More information

Small and Big Operations: New Tools of the Trade for Brain Tumors. Disclosure. Incidence of Childhood Cancer

Small and Big Operations: New Tools of the Trade for Brain Tumors. Disclosure. Incidence of Childhood Cancer Small and Big Operations: New Tools of the Trade for Brain Tumors Nalin Gupta MD PhD Chief, Division of Pediatric Neurosurgery Departments of Neurosurgery and Pediatrics University of California San Francisco

More information

Patterns of Brain Tumor Recurrence Predicted From DTI Tractography

Patterns of Brain Tumor Recurrence Predicted From DTI Tractography Patterns of Brain Tumor Recurrence Predicted From DTI Tractography Anitha Priya Krishnan 1, Isaac Asher 2, Dave Fuller 2, Delphine Davis 3, Paul Okunieff 2, Walter O Dell 1,2 Department of Biomedical Engineering

More information

NO MORE NEWS AN EVIDENCE BASED APPROACH ON LASERS IN SKIN OF COLOR PATIENTS DR. EDUARDO WEISS, M.D., FAAD

NO MORE NEWS AN EVIDENCE BASED APPROACH ON LASERS IN SKIN OF COLOR PATIENTS DR. EDUARDO WEISS, M.D., FAAD NO MORE NEWS AN EVIDENCE BASED APPROACH ON LASERS IN SKIN OF COLOR PATIENTS DR. EDUARDO WEISS, M.D., FAAD KEY POINTS Hispanics/Latinos are the fastest growing segment of the skin of color population Use

More information

Up to date literature at your disposal to discover the benefits of laser dentistry

Up to date literature at your disposal to discover the benefits of laser dentistry Up to date literature at your disposal to discover the benefits of laser dentistry For further information contact info@doctor-smile.com +39-0444-349165 Dipartimento di Scienze e Tecnologie Biofisiche

More information

EPILEPSY. New Ideas about an Old Disease. Gregory D. Cascino, MD

EPILEPSY. New Ideas about an Old Disease. Gregory D. Cascino, MD EPILEPSY New Ideas about an Old Disease Gregory D. Cascino, MD Disclosure Research-Educational Grants Neuro Pace, Inc. American Epilepsy Society American Academy of Neurology Neurology (Associate Editor)

More information

Otolaryngologist s Perspective of Stereotactic Radiosurgery

Otolaryngologist s Perspective of Stereotactic Radiosurgery Otolaryngologist s Perspective of Stereotactic Radiosurgery Douglas E. Mattox, M.D. 25 th Alexandria International Combined ORL Conference April 18-20, 2007 Acoustic Neuroma Benign tumor of the schwann

More information

The Management of Advanced Stage Hepatocellular Carcinoma

The Management of Advanced Stage Hepatocellular Carcinoma The Management of Advanced Stage Hepatocellular Carcinoma Pierce K.H Chow MD PhD Professor, Duke-NUS Graduate Medical School Singapore Senior Consultant Surgeon, National Cancer Center Singapore Senior

More information

PEDIATRIC ORBITAL TUMORS RADIOTHERAPY PLANNING

PEDIATRIC ORBITAL TUMORS RADIOTHERAPY PLANNING PEDIATRIC ORBITAL TUMORS RADIOTHERAPY PLANNING ANATOMY ANATOMY CONT ANATOMY CONT. ANATOMY CONT. EYE OF A CHILD Normal tissue tolerance doses (in conventional #) TD 5/5 TD 50/5 Endpoint Gy Gy Optic nerve

More information

Primary brain tumours and cerebral metastases workshop

Primary brain tumours and cerebral metastases workshop Primary brain tumours and cerebral workshop 22.4.16 Summary of workshop group discussions on the content of the scope Scope section Title: Primary brain tumours and cerebral Who the guideline is for People

More information

Stereotactic Body Radiation Therapy and Radiofrequency Ablation 2014 Masters of Minimally Invasive Surgery

Stereotactic Body Radiation Therapy and Radiofrequency Ablation 2014 Masters of Minimally Invasive Surgery Stereotactic Body Radiation Therapy and Radiofrequency Ablation 2014 Masters of Minimally Invasive Surgery Matthew Hartwig, M.D. Duke Cancer Institute Case Presentation I: Patient ER 74 y/o male with A1A

More information

Regional Neuro-Oncology Service Information Evening

Regional Neuro-Oncology Service Information Evening Regional Neuro-Oncology Service Information Evening Dr Tom Flannery Information Evening hosted by Brainwaves NI, in partnership with the Northern Ireland Regional Neuro-Oncology Multi Disciplinary Team.

More information

LOW GRADE ASTROCYTOMAS

LOW GRADE ASTROCYTOMAS LOW GRADE ASTROCYTOMAS This article was provided to us by David Schiff, MD, Associate Professor of Neurology, Neurosurgery, and Medicine at University of Virginia, Charlottesville. We appreciate his generous

More information

Lasers in Gastroenterology, Otorhinolaryngology & Pulmonology

Lasers in Gastroenterology, Otorhinolaryngology & Pulmonology Lasers in Gastroenterology, Otorhinolaryngology & Pulmonology Eloise Anguluan Laser-Tissue Interactions Fall Semester 2016 Gastroenterology the branch of medicine which deals with disorders of the stomach

More information

China Medical Technologies, Inc.

China Medical Technologies, Inc. China Medical Technologies, Inc. China Medical Technologies, Inc. (CMT) is a high-tech enterprise, trading on Nasdaq with the ticker CMED. We currently conduct our operations principally through our wholly-owned

More information

Cold Laser Program ML830

Cold Laser Program ML830 Cold Laser Program ML830 The Microlight ML830 Cold Laser, started everything 25 years ago. It was developed in 1985, by leading european doctors and engineers. The laser was brought to the USA in 1990,

More information

fmri and Tractography in Preoperative Neurosurgical Planning Ronald L. Wolf, M.D., Ph.D. University of Pennsylvania Medical Center

fmri and Tractography in Preoperative Neurosurgical Planning Ronald L. Wolf, M.D., Ph.D. University of Pennsylvania Medical Center fmri and Tractography in Preoperative Neurosurgical Planning Ronald L. Wolf, M.D., Ph.D. University of Pennsylvania Medical Center Acknowledgements/Disclosures Radiology Ragini Verma Birkan Tunc Sumei

More information

The Role of Radiation Therapy in the Treatment of Brain Metastases. Matthew Cavey, M.D.

The Role of Radiation Therapy in the Treatment of Brain Metastases. Matthew Cavey, M.D. The Role of Radiation Therapy in the Treatment of Brain Metastases Matthew Cavey, M.D. Objectives Provide information about the prospective trials that are driving the treatment of patients with brain

More information

MANAGEMENT N OF PRIMARY BRAIN TUMOURS IN THE ELDERLY

MANAGEMENT N OF PRIMARY BRAIN TUMOURS IN THE ELDERLY MANAGEMENT N OF PRIMARY BRAIN TUMOURS IN THE ELDERLY Meningioma, Glioma, Lymphoma Cornu Ph, Keime-Guibert F, Hoang-Xuan K, Pierga JY, Delattre JY Neuro-oncology Group of Pitie-Salpetriere hospital-paris-france

More information

UCSF Uveal Melanoma Program: Outcomes with Proton Beam Radiation Therapy Kavita K. Mishra, M.D., M.P.H. UCSF Comprehensive Cancer Center

UCSF Uveal Melanoma Program: Outcomes with Proton Beam Radiation Therapy Kavita K. Mishra, M.D., M.P.H. UCSF Comprehensive Cancer Center Disclosures UCSF Uveal Melanoma Program: Outcomes with Proton Beam Radiation Therapy No disclosures Kavita K. Mishra, M.D., M.P.H. UCSF Comprehensive Cancer Center UCSF Uveal Melanoma Program: Ocular Melanoma

More information

Brain and Spine Tumors

Brain and Spine Tumors Brain and Spine Tumors Andrew J. Fabiano, MD FAANS Associate Professor of Neurosurgery Roswell Park Cancer Institute SUNY at Buffalo School of Medicine Brain Tumors Brain Tumor Basics Types of Tumors Cases

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM BRAIN METASTASES CNS Site Group Brain Metastases Author: Dr. Norm Laperriere Date: February 20, 2018 1. INTRODUCTION

More information

Introduction to Lasers

Introduction to Lasers Introduction to Lasers Mastership with the Academy of Laser Dentistry In-Office Laser Consultant for LVI Course Outcome Hygienists will be able to know: Understand Laser Physics Define which lasers can

More information

Innovative Multimodal Imaging Techniques in Brain Tumor Clinical Trials

Innovative Multimodal Imaging Techniques in Brain Tumor Clinical Trials Innovative Multimodal Imaging Techniques in Brain Tumor Clinical Trials Benjamin M. Ellingson, Ph.D. Assistant Professor of Radiology, Biomedical Physics, and Bioengineering Brain Tumor Imaging Laboratory

More information

Glioblastoma (GBM) is the most common malignant. focus Neurosurg Focus 41 (4):E12, 2016

Glioblastoma (GBM) is the most common malignant. focus Neurosurg Focus 41 (4):E12, 2016 neurosurgical focus Neurosurg Focus 41 (4):E12, 2016 Laser interstitial thermal therapy for newly diagnosed and recurrent glioblastoma Jonathan G. Thomas, MD, 1 Ganesh Rao, MD, 1 Yvonne Kew, MD, PhD, 2

More information

Imaging for suspected glioma

Imaging for suspected glioma Imaging for suspected glioma 1.1.1 Offer standard structural MRI (defined as T2 weighted, FLAIR, DWI series and T1 pre- and post-contrast volume) as the initial diagnostic test for suspected glioma, unless

More information

Introduction to Neurosurgical Subspecialties:

Introduction to Neurosurgical Subspecialties: Introduction to Neurosurgical Subspecialties: Tumor and Skull Base Neurosurgery Brian L. Hoh, MD 1 and Gregory J. Zipfel, MD 2 1 University of Florida, 2 Washington University Tumor / Skull Base Neurosurgery

More information

MRI Applications in Radiation Oncology:

MRI Applications in Radiation Oncology: MRI Applications in Radiation Oncology: Physician s Perspective Jeff Olsen, MD Department of Radiation Oncology Washington University, St. Louis, MO Disclosures Washington University has research and service

More information

Percutaneous Laser Discectomy: Experience and Long Term Follow-Up

Percutaneous Laser Discectomy: Experience and Long Term Follow-Up Percutaneous Laser Discectomy: Experience and Long Term Follow-Up P.P.M. Menchetti, G. Canero, and W. Bini Abstract The classical microsurgical approach in the treatment of herniated nucleus pulposus (HNP)

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM MENINGIOMA CNS Site Group Meningioma Author: Dr. Norm Laperriere Date: February 20, 2018 1. INTRODUCTION 3 2. PREVENTION

More information

Selecting the Optimal Treatment for Brain Metastases

Selecting the Optimal Treatment for Brain Metastases Selecting the Optimal Treatment for Brain Metastases Clinical Practice Today CME Co-provided by Learning Objectives Upon completion, participants should be able to: Understand the benefits, limitations,

More information

Mehmet Ufuk ABACIOĞLU Neolife Medical Center, İstanbul, Turkey

Mehmet Ufuk ABACIOĞLU Neolife Medical Center, İstanbul, Turkey Updated Oncology 2015: State of the Art News & Challenging Topics CURRENT STATUS OF STEREOTACTIC RADIOSURGERY IN BRAIN METASTASES Mehmet Ufuk ABACIOĞLU Neolife Medical Center, İstanbul, Turkey Bucharest,

More information

Case Scenario 1. 2/15/2011 The patient received IMRT 45 Gy at 1.8 Gy per fraction for 25 fractions.

Case Scenario 1. 2/15/2011 The patient received IMRT 45 Gy at 1.8 Gy per fraction for 25 fractions. Case Scenario 1 1/3/11 A 57 year old white female presents for her annual mammogram and is found to have a suspicious area of calcification, spread out over at least 4 centimeters. She is scheduled to

More information

Challenging Paediatric Brain Tumours. ASP Belfast March 2017 Dr Jane Pears Consultant Paediatric Oncologist, Dublin

Challenging Paediatric Brain Tumours. ASP Belfast March 2017 Dr Jane Pears Consultant Paediatric Oncologist, Dublin Challenging Paediatric Brain Tumours ASP Belfast March 2017 Dr Jane Pears Consultant Paediatric Oncologist, Dublin Overview (i) Paediatric malignancy (ii) Central nervous system tumours (iii) Diffuse Intrinsic

More information

Next Generation Technologies for Intra-Operative Tumor Detection. Pramod Butte, MBBS, PhD

Next Generation Technologies for Intra-Operative Tumor Detection. Pramod Butte, MBBS, PhD Next Generation Technologies for Intra-Operative Tumor Detection Pramod Butte, MBBS, PhD Background It is estimated that 40,000 new cases of primary brain tumors. More than 350,000 persons are living with

More information

Laryngeal Preservation Using Radiation Therapy. Chemotherapy and Organ Preservation

Laryngeal Preservation Using Radiation Therapy. Chemotherapy and Organ Preservation 1 Laryngeal Preservation Using Radiation Therapy 1903: Schepegrell was the first to perform radiation therapy for the treatment of laryngeal cancer Conventional external beam radiation produced disappointing

More information

Life after ARUBA: Management of Unruptured Brain Arteriovenous Malformations (AVMs)

Life after ARUBA: Management of Unruptured Brain Arteriovenous Malformations (AVMs) Life after ARUBA: Management of Unruptured Brain Arteriovenous Malformations (AVMs) Eric L. Zager, MD University of Pennsylvania Department of Neurosurgery No Disclosures Brain AVMs Incidence ~1 in 100,000

More information

Laser in Neurosurgery, Angioplasty & Cardiology

Laser in Neurosurgery, Angioplasty & Cardiology Laser in Neurosurgery, Angioplasty & Cardiology EECS Gwangju Institute of Science and Technology, Korea Seungmin Lee 20161023 What is neurosurgery? Neurosurgery deals with diseases of the central nervous

More information

Specialised Services Policy: CP22. Stereotactic Radiosurgery

Specialised Services Policy: CP22. Stereotactic Radiosurgery Specialised Services Policy: CP22 Document Author: Assistant Director of Planning Executive Lead: Director of Planning ad Performance Approved by: Management Group Issue Date: 01 July 2015 Review Date:

More information

SUCCESSFUL TREATMENT OF METASTATIC BRAIN TUMOR BY CYBERKNIFE: A CASE REPORT

SUCCESSFUL TREATMENT OF METASTATIC BRAIN TUMOR BY CYBERKNIFE: A CASE REPORT SUCCESSFUL TREATMENT OF METASTATIC BRAIN TUMOR BY CYBERKNIFE: A CASE REPORT Cheng-Ta Hsieh, 1 Cheng-Fu Chang, 1 Ming-Ying Liu, 1 Li-Ping Chang, 2 Dueng-Yuan Hueng, 3 Steven D. Chang, 4 and Da-Tong Ju 1

More information

Surgery for Medically Refractory Focal Epilepsy

Surgery for Medically Refractory Focal Epilepsy Surgery for Medically Refractory Focal Epilepsy Seth F Oliveria, MD PhD The Oregon Clinic Neurosurgery Director of Functional Neurosurgery: Providence Brain and Spine Institute Portland, OR Providence

More information

SCIENTIFIC PROGRAMME SNOLA UPDATE ON NEURO- ONCOLOGY th March

SCIENTIFIC PROGRAMME SNOLA UPDATE ON NEURO- ONCOLOGY th March SCIENTIFIC PROGRAMME SNOLA UPDATE ON NEURO- ONCOLOGY 2016 24th March 13h 13h45 pathology case case parasellar meningeoma case : posterior fossa pediatric tumor 13h45 16h Imaging for CNS lymphomas Parasellar

More information

Endovenous Laser Ablation

Endovenous Laser Ablation Endovenous Laser Ablation 132 nm Wavelength with Clear Tip Technology vs. 147 nm Wavelength Similarities and Differences 132nm and 147nm Both wavelengths are mid-infrared Water is the primary chromophore

More information

Hypofractionated Radiotherapy for breast cancer: Updated evidence

Hypofractionated Radiotherapy for breast cancer: Updated evidence 2 rd Bangladesh Breast Cancer Conference, Dhaka, December 2017 Hypofractionated Radiotherapy for breast cancer: Updated evidence Tabassum Wadasadawala Associate Professor of Radiation Oncology Tata Memorial

More information

Selected radiosurgery cases from the Rotating Gamma Institute Debrecen, Hungary

Selected radiosurgery cases from the Rotating Gamma Institute Debrecen, Hungary Selected radiosurgery cases from the Rotating Gamma Institute Debrecen, Hungary László Bognár M.D., Ph.D., József G. Dobai M.D., Gábor Csiky and Imre Fedorcsák M.D., Ph.D. Department of Neurosurgery, Medical

More information

DOES RADIOTHERAPY TECHNIQUE / DOSE / FRACTIONATION REALLY MATTER? YES

DOES RADIOTHERAPY TECHNIQUE / DOSE / FRACTIONATION REALLY MATTER? YES DOES RADIOTHERAPY TECHNIQUE / DOSE / FRACTIONATION REALLY MATTER? YES Marco Krengli Radiotherapy, Department of Translational Medicine, University of Piemonte Orientale A. Avogadro THE STANDARD OF CARE

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM ANAPLASTIC GLIOMAS CNS Site Group Anaplastic Gliomas Author: Dr. Norm Laperriere Date: February 20, 2018 1. INTRODUCTION

More information

Treatment of Leg Telangiectasia (Spider Veins) with Magma Long Pulse ND - Laser 1064 nm Case Study

Treatment of Leg Telangiectasia (Spider Veins) with Magma Long Pulse ND - Laser 1064 nm Case Study Clinical Study Treatment of Leg Telangiectasia (Spider Veins) with Magma Long Pulse ND - Laser 1064 nm Case Study Sharona Levi-Friedman CRA, E. Krieger MD, Formatk Systems Ltd. Tirat- Carmel, Israel. 1.

More information

Radioterapia no Tratamento dos Gliomas de Baixo Grau

Radioterapia no Tratamento dos Gliomas de Baixo Grau Radioterapia no Tratamento dos Gliomas de Baixo Grau Dr. Luis Souhami University Montreal - Canada Low Grade Gliomas Relatively rare Heterogeneous, slow growing tumors WHO Classification Grade I Pilocytic

More information

Modeling origin and natural evolution of low-grade gliomas

Modeling origin and natural evolution of low-grade gliomas Modeling origin and natural evolution of low-grade gliomas Mathilde Badoual Paris Diderot University, IMNC lab 2nd HTE workshop: Mathematical & Computer Modeling to study tumors heterogeneity in its ecosystem,

More information

Hepatocellular Carcinoma: Transplantation, Resection or Ablation?

Hepatocellular Carcinoma: Transplantation, Resection or Ablation? Hepatocellular Carcinoma: Transplantation, Resection or Ablation? Roberto Gedaly MD Chief, Abdominal Transplantation Transplant Service Line University of Kentucky Nothing to disclose Disclosure Objective

More information

Updated Imaging for Novel Pancreatic Cancer Therapy. Desiree E. Morgan, MD FSCBTMR Professor and Vice Chair Education

Updated Imaging for Novel Pancreatic Cancer Therapy. Desiree E. Morgan, MD FSCBTMR Professor and Vice Chair Education Updated Imaging for Novel Pancreatic Cancer Therapy Desiree E. Morgan, MD FSCBTMR Professor and Vice Chair Education Disclosures I have no financial disclosures relevant to the educational content of this

More information

General Identification. Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27

General Identification. Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27 General Identification Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27 Chief Complaint Sudden onset of seizure for several minutes Present illness This 29-year

More information

Where are we with radiotherapy for biliary tract cancers?

Where are we with radiotherapy for biliary tract cancers? Where are we with radiotherapy for biliary tract cancers? Professor Maria A. Hawkins Associate Professor in Clinical Oncology MRC Group Leader/Honorary Consultant Clinical Oncologist CRUK MRC Oxford Institute

More information

Oncological Management of Brain Tumours. Anna Maria Shiarli SpR in Clinical Oncology 15 th July 2013

Oncological Management of Brain Tumours. Anna Maria Shiarli SpR in Clinical Oncology 15 th July 2013 Oncological Management of Brain Tumours Anna Maria Shiarli SpR in Clinical Oncology 15 th July 2013 Outline General considerations of Primary Brain Tumours: epidemiology, pathology, presentation. Diagnosis

More information

Lasers in Urology. Laser Tissue Interaction, November 28 th, Qureshi, Muhammad Mohsin. Biomedical in vivo Opto-scopy Laboratory

Lasers in Urology. Laser Tissue Interaction, November 28 th, Qureshi, Muhammad Mohsin. Biomedical in vivo Opto-scopy Laboratory Laser Tissue Interaction, November 28 th, 2016 Lasers in Urology Qureshi, Muhammad Mohsin Gwangju Institute of Science and Technology Biomedical in vivo Opto-scopy Laboratory 2 Content Introduction to

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM EPENDYMOMA Last Revision Date July 2015 1 CNS Site Group Ependymoma Author: Dr. Norm Laperriere 1. INTRODUCTION 3 2.

More information

Prior Authorization Review Panel MCO Policy Submission

Prior Authorization Review Panel MCO Policy Submission Prior Authorization Review Panel MCO Policy Submission A separate copy of this form must accompany each policy submitted for review. Policies submitted without this form will not be considered for review.

More information

Oligodendrogliomas & Oligoastrocytomas

Oligodendrogliomas & Oligoastrocytomas Oligodendrogliomas & Oligoastrocytomas ABOUT THE AMERICAN BRAIN TUMOR ASSOCIATION Founded in 1973, the American Brain Tumor Association (ABTA) was the first national nonprofit organization dedicated solely

More information

Achieving Clinically Proven Treatment Results With Photodynamic Therapy (PDT) and PHOTOFRIN (porfimer sodium) for Injection

Achieving Clinically Proven Treatment Results With Photodynamic Therapy (PDT) and PHOTOFRIN (porfimer sodium) for Injection Achieving Clinically Proven Treatment Results With Photodynamic Therapy () and PHOTOFRIN (porfimer sodium) for Injection PHOTOFRIN (porfimer sodium) IS INDICATED FOR Palliation of patients with completely

More information

Treatment results of proton beam therapy with chemo-radiotherapy for stage I-III esophageal cancer

Treatment results of proton beam therapy with chemo-radiotherapy for stage I-III esophageal cancer Treatment results of proton beam therapy with chemo-radiotherapy for stage I-III esophageal cancer Nobukazu Fuwa 1, Akinori Takada 2 and Takahiro Kato 3 1;Departments of Radiology, Hyogo Ion Beam Medical

More information

Radiotherapy What are our options and what is on the horizon. Dr Kevin So Specialist Radiation Oncologist Epworth Radiation Oncology

Radiotherapy What are our options and what is on the horizon. Dr Kevin So Specialist Radiation Oncologist Epworth Radiation Oncology Radiotherapy What are our options and what is on the horizon Dr Kevin So Specialist Radiation Oncologist Epworth Radiation Oncology Outline Advances in radiotherapy technique Oligo - disease Advancements

More information

Stress Wave Focusing Transducers

Stress Wave Focusing Transducers UCRL-K-130697 PREPRINT Stress Wave Focusing Transducers Steven R. Visuri, Richard A. London, Luiz Da Silva This paper was prepared for submittal to Optical Society of America, Spring Topical Meetings Orlando,

More information

Non-invasive Neurosurgery using MR guided Focused Ultrasound

Non-invasive Neurosurgery using MR guided Focused Ultrasound Non-invasive Neurosurgery using MR guided Focused Ultrasound About InSightec Founded in 1999, headquarters Haifa, Israel US offices in Dallas, Texas Asian offices in Beijing, China, and Tokyo, Japan Develop

More information

Lymphocyte Predominant Hodgkin s Lymphoma. Case Presentation. How would you treat the patient?

Lymphocyte Predominant Hodgkin s Lymphoma. Case Presentation. How would you treat the patient? Lymphocyte Predominant Hodgkin s Lymphoma Wei Ai, MD, PhD Assistant Clinical Professor University of California, San Francisco January 2010 Case Presentation 32 yo male, diagnosed with stage IIIA lymphocyte

More information

Stereotactic Diffusion Tensor Tractography For Gamma Knife Stereotactic Radiosurgery

Stereotactic Diffusion Tensor Tractography For Gamma Knife Stereotactic Radiosurgery Disclosures The authors of this study declare that they have no commercial or other interests in the presentation of this study. This study does not contain any use of offlabel devices or treatments. Stereotactic

More information

Photocoagulation of disciform macular lesions

Photocoagulation of disciform macular lesions British Journal of Ophthalmology, 1979, 63, 669-673 Photocoagulation of disciform macular lesions with krypton laser A. C. BIRD AND R. H. B. GREY From the Institute of Ophthalmology, Moorfields Eye Hospital,

More information

THE EFFECTIVE OF BRAIN CANCER AND XAY BETWEEN THEORY AND IMPLEMENTATION. Mustafa Rashid Issa

THE EFFECTIVE OF BRAIN CANCER AND XAY BETWEEN THEORY AND IMPLEMENTATION. Mustafa Rashid Issa THE EFFECTIVE OF BRAIN CANCER AND XAY BETWEEN THEORY AND IMPLEMENTATION Mustafa Rashid Issa ABSTRACT: Illustrate malignant tumors that form either in the brain or in the nerves originating in the brain.

More information

Presentation Product & clinics

Presentation Product & clinics Presentation Product & clinics Design What s Long Pulse Nd:YAG? medium YAG (Yuttrium Aluminum Garnet : Y 3 Al 5 O 12 ) + Nd 3+ The Wavelength Penetrates All kind of Hair removal Each laser possesses specific

More information