Fight pancreatic cancer with precision! The team of Tianjin Medical University Cancer Hospital completed the world's first mobile CT image-guided intraoperative precision radiotherapy for pancreatic cancer

Pancreatic cancer is one of the common malignant tumors of the digestive tract and is known as the "king of cancer" in the field of tumors
.
According to The Lancet, pancreatic cancer has a five-year survival rate of about 10% after diagnosis, making it one of
the worst malignant tumors.
At present, the fundamental treatment principle for pancreatic cancer is still mainly surgical treatment, but due to its high degree of malignancy and low surgical resection rate, it leads to poor
prognosis.
To improve the curative degree of surgery and reduce postoperative recurrence and metastasis, radiation therapy to potentially high-risk areas is one of
the effective methods.

This article is the original of Translational Medicine Network, please indicate the source of reprinting

Written by Mia

Recently, Hao Jihui, president of Tianjin Medical University Cancer Hospital, led the team to cooperate with pancreatic oncology, radiation therapy and other multidisciplinary cooperation to complete the world's first mobile CT image-guided intraoperative precision radiotherapy
for pancreatic cancer.
This operation implements one-stop "surgery + three-dimensional imaging + precise positioning + radiotherapy" to carry out "precise strikes" on pancreatic cancer and reduce the risk of
postoperative recurrence and metastasis.

Image source: Cancer Hospital of Tianjin Medical University

Current status of pancreatic cancer treatment

 01 

Pancreatic cancer is one of the common malignant tumors of the digestive tract and is known as the "king of cancer" in the field of tumors
.
According to The Lancet, pancreatic cancer has a five-year survival rate of about 10% after diagnosis, making it one of
the worst malignant tumors.
At present, the fundamental treatment principle for pancreatic cancer is still mainly surgical treatment, but due to its high degree of malignancy and low surgical resection rate, it leads to poor
prognosis.
As with most tumors, there is no comprehensive treatment option
that is highly effective and fully applicable.
At present, comprehensive treatment is still mainly based on surgical treatment, supplemented by radiotherapy and chemotherapy, and new methods
of combining immunological and molecular biological therapies are being explored.

Nowadays, with the rapid progress of research on radiotherapy equipment, imaging technology, artificial intelligence, etc.
, radiotherapy has entered the era of
precision.
With the completion of precision "radiotherapy weapons", the corresponding radiotherapy treatment mode has also changed, from the conventional dose mode to the direction of large-segmentation, stereotactic radiotherapy (SBRT), and the target area ranges from large-scale irradiation to visible lesion radiotherapy
.
The technology and concept of radiotherapy for pancreatic cancer in China do not lag behind foreign countries, as early as the end of the last century, X-knife or gamma knife has begun to be used to treat pancreatic cancer, and the high-dose and fractional radiotherapy dose model has also been proposed accordingly, and the data results are better than the conventional dose model
.
To improve the curative degree of surgery and reduce postoperative recurrence and metastasis, radiation therapy to potentially high-risk areas is one of
the effective methods.

"Precise strike" against pancreatic cancer cells

 02 

In order to maximize the efficacy of radiotherapy during surgery, Hao Jihui's team collaborated with multiple disciplines to advance postoperative external radiation to intraoperative radiation and irradiate low-energy X-rays on the tumor bed
after tumor removal.
Compared with postoperative radiotherapy, intraoperative radiotherapy can reduce recurrence and improve the rate
of local tumor control.

The team independently developed a three-dimensional intraoperative radiotherapy planning system
based on intraoperative CT 3D imaging.
During the operation, doctors can accurately judge the area of intraoperative radiotherapy, outline the target area, and intuitively see the three-dimensional dose distribution information of the intraoperative radiotherapy site and the area with a high risk of recurrence, so that the judgment of the effect of intraoperative radiotherapy is more accurate, and the surrounding tissues and organs
can be more meticulously protected.

In addition, the team pioneered the integration of multiple new technologies and methods
for intraoperative image guidance.
These include the use of advanced intraoperative CT equipment and unique artifact removal technology to quickly and accurately acquire high-quality images of the patient's intraoperative tumor bed area within 30 seconds; According to intraoperative real-time CT, the tumor bed and high-risk areas of recurrence were quickly delineated, and three-dimensional images and dose distribution were calculated and obtained.
Accurate and fast dose stacking
based on live images.

Hao Jihui: Promote precision intraoperative radiotherapy technology

 03 

Hao Jihui is the president and party committee member
of Tianjin Medical University Cancer Hospital.
He is also a youth committee member of the Oncology Branch of the Chinese Medical Association and a review expert of
the National Natural Science Foundation of China.

Dean Hao Jihui specializes in all kinds of benign and malignant pancreatic tumor surgery
.
He has in-depth research
on accurate diagnosis, fine surgery, and individualized comprehensive treatment of pancreatic tumors.
He has been actively promoting a standardized and individualized comprehensive treatment model
for pancreatic cancer.
He pioneered "radical sweeping of the skeletal vascularization of the encircular process" and "peripancreatic nerve clearance along the retroperitoneal border", advocating the use of electrosurgical equipment to improve surgical safety and shorten the operation time
.
In addition, he has presided over difficult surgeries such as total pancreatic resection, pancreatic tail cancer resection combined with abdominal dry dissection, and pancreaticoduodenectomy combined with posterior peritoneal enlargement dissection + portal vein replacement, which has significantly improved the surgical resection rate and long-term survival rate
of pancreatic cancer.

Dean Hao Jihui introduced that the three-dimensional intraoperative radiotherapy planning system can accurately locate the intraoperative irradiation target, further improve the effect of intraoperative radiation to kill cancer cells, and protect the normal tissues
of the radiotherapy area.
He believes that the future trend is to extend precision intraoperative radiotherapy technology to more other cancer treatments
.

Resources:

http://epaper.
tianjinwe.
com/mrxb/html/2022-10/27/content_19046_6889091.
htm

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