7th November, Labex TRAIL

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1 7th November, 2014 Labex TRAIL

2 The Translational Research and Advanced Imaging Laboratory (TRAIL) program seeks to facilitate interdisciplinary, collaborative basic and clinical research in image-based diagnostics and novel bio-compatible technologies for evaluating treatments, interventions and drug delivery strategies. It will also provide evaluation on imaging techniques for patient care, public health impact and medico-economics impact.

3 1. To enforce our fundamental imaging science 1. To reduce obstacles to translational research (T1) from bench to bedside 1. To study the impact of our research (T2), new methods and new imaging technologies on clinical trials, personalized medicine, patient care, epidemiology and socio-economic impact 1. To provide a one-stop solution and showcase promoting relationships with industrial partners 1. To promote education for appropriate job qualifications and better social integration 1. To set up a strong governing organization and an internal management

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7 TRAIL RESEARCH PORTFOLIO : 23 PROJECTS, 3.164M ABACI: Automated Brain anatomy softwares for cohort imaging, 2012, (neuro) TRAIL&TRACKS: Atlasing white matter tracts, 2011, (neuro) COBRASCAN: Quantitative computed tomography for phenotyping COPD within COBRA cohort, 2013, (pneumo) HIFU: Alteration of the blood brain barrier induced by HIFU, 2012, (onco) MRGHIFU: Methodological developments for applications of HIFU in cardiology and oncology, 2013, (cardio-onco) ACTE: Cognitive training and brain functional connectivity, 2012, (neuro) HR-DTI: Developping High-Resolution DTI method, 2012, (neuro) MOD: Mathematical modeling of the response to antiangiogenic drugs via medical imaging, 2013, (onco) CRYOIMMUNO: Cryo immunotherapy of metastatic renal carcinoma, 2014, (onco) NEKOMRI: MRI sequence for bronchial wall segmentation and analysis, 2014, (pneumo) BIOPSYPROSTAPROBE: Antibody-based fluorescence probe for biopsy Guidance of prostate cancer, 2014, (onco) IBIO-NI: New Imaging Biomarkers of neuroinflammation such as MS, 2012, (neuro) INNES: Lactate and neuronal metabolism, 2011, (neuro) SCICOG&REACTIV: Imaging biomarker in MS, 2011, (neuro) New sequences, DNP NEWFISP: Improving MRI resolution to correctly MRIdiagnose cardiac pathologies and metastases, 2012, (cardio-onco) TRAILDNP: To improve in vivo DNP in mice at 0.2T, 2011, (neuro) ONCOFLUX: Metabolic flux MR imaging in tumors, 2013, (onco) IMMELAPT: Detecting tumors using SPECT molecular imaging and optimized aptamers, 2012, (onco) PRITOR: NeuroPeptide Receptors Imaging for TumOR Targeting, 2013, (onco) SUPSIFLU: Supported Silyl Fluorination, 2013, (onco) PIAF: 18F for PET-imaging angiogenesis, 2011, (onco) TRANSFEAR: Cerebral structure changes involved in

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9 Interface between technology, clinical, human and social science and public health: Case study interventional radiology Technique, research and benefits Jean Palussière, Bergonié Institute

10 Interventional Radiology in Oncology Image-guided procedures Diagnosis : Biopsies Therapy : Curative Thermal Ablation Local delivering of therapies loaded with beads, liposomes : Y90, chemotherapy, genes Therapy : Palliative Stomies, drainage, stents, cementoplasties. MINI INVASIVE 10

11 Thermal ablation : to kill cells with temperature modifications (heating from 70 to 150 C, freezing 50 C) Since 1995 used to treat liver tumors, then lung, renal bone tumors 11

12 Thermal ablation : to kill cells with temperature modifications (heating from 70 to 150 C, freezing 50 C) Since 1995 used to treat liver tumors, then lung, renal bone tumors Few data on breast tumors Breast-conservative Surgery : lumpectomy followed by whole breast radiation therapy Minimally-invasive non-surgical technique for the treatment of small breast malignancies? First publications with RFA to ablate and to resect Fornage B Radiology

13 Breast thermal ablation From 2004 to determine the efficacy and tolerance of percutaneous radiofrequency ablation (RFA) with endocrine therapy for elderly breast cancer patients refusing, or not candidates for surgery. Women in the elderly Oral Endocrine therapy To add a local treatment Reduces morbidity breast cancer Increases survival RF as a local treatment? 13

14 Breast thermal ablation Radiology 2012 Aug;264(2): Feasibility under local anesthesia and loco-regional anesthesia Good long term efficacy on tumors less than 2 cm to exclude invasive lobular carcinoma particularly adapted for elderly patients. Long-term follow-up shows no delayed local and cosmetic complications 14

15 Breast thermal ablation Before RF 2 M 6 M 15

16 Breast thermal ablation Other techniques Cryotherapy advantages larger lesions, closer to the skin, less painful 16

17 Breast thermal ablation Limits : Absence of margin control : MRI is mandatory for the follow up Lymph node status : sentinel To enlarge the indications with MRI guided HIFU? Few teams are working on this topic : Canada, Japan, Israel (GE-Insightec), Utrecht (Philips) 17

18 Exemple of a translational research 18

19 Breast thermal ablation HIFU program Tensioning device Integrated 11- channel RF coil element transducer, 1 MHz Payne, A. et al., Med Phys 39 (1552), 2012 Minalga, E. et al., MRM, 69: (2013) 19

20 Breast thermal ablation HIFU program E Minalga et almagnetic Resonance in Medicine 69: (2013) 20

21 Breast thermal ablation HIFU program Validate ablation capabilities in vivo Treat breasts (udders) of varying sizes in the system Evaluate 3D MRTI techniques in vivo Assess both focal region and near-field heating Verify focal spot positioning accuracy Correlate 3D thermal dose measurements to DCE- MRI results 21

22 Breast thermal ablation HIFU program 3D segmented EPI FA = 15 MR Temperature Imaging TR/TE = 35/10 ms 2 x 2 x 2 mm 4.9 s acquisition FOV = 256 x 190 x Hz/pixel mm 22

23 Breast thermal ablation HIFU program 3.64 cm 3 CEM 20 minutes post-ablation 10,13 cm 3 thermal dose > 240 CEM 14 days 3.24 cm 3 Thermoguide 23

24 Breast thermal ablation HIFU program Phase I study ( ) Patients whose pathologic data given by biopsies are sufficient for treatment. T0 (15 mm US) N0 HIFU treatment followed by surgery (lumpectomy or mastectomy) at least 48H between HIFU and surgery. Pathologic evaluation of ablation zone 24

25 Breast thermal ablation HIFU program Main objectives : To validate the ablation zone : To evaluate the efficacy of HIFU ablation of breast tumors with histo-pathologic criteria measuring tumor destruction. Non invasive : to evaluate the HIFU ablation zone as a preoperatory marker of the tumoral area to resect 25

26 Breast thermal ablation HIFU program Funding BORDEAUX HIFU system : FLI MRI Bergonié : 10% dedicated to research funded by Conseil régional d Aquitaine Clinical study : Ligue contre le cancer? SIRIC BRIO Adjustment : IDEX Bordeaux 3 months stay D Parker LabEx TRAIL 30% post Doc IGT : research engineer Siemens : MR application specialist 26

27 Breast thermal ablation HIFU program Funding Salt Lake City Funding NIH Additional 5 years to develop human applications in the United States 27

28 Breast thermal ablation HIFU program Innovative therapy : To improve breast cancer treatment in developping minimally invasive treatments Outpatient basis Transfer to industrialization IGT/Utah Economic development 28

29 Breast thermal ablation Limits : Absence of margin control : MRI is mandatory for the follow up Lymph node status : sentinel To enlarge the indications with MRI guided HIFU? Few teams are working on this topic : Canada, Japan, Israel (GE-Insightec), Utrecht (Philips) 29