Health Valley Event Presentatie John Lapré

Scherpschieten op de prostaat “ Van handbediend naar automaat” John Lapré Vice-President R&D Nucletron

Nucletron is a world-wide player in radiation therapy solutions headquartered in Veenendaal
Founded in 1975
125 Million Euro Sales with 15 Million Euro R&D investment
550 employees (180 in Veenendaal) of which 100 in R&D
Offices in 20 countries, presence in > 100 countries& Products used in 2,500 clinics worldwide
Leader in Brachytherapy with complete solutions offering
Independent supplier of external beam treatment planning solutions

Nucletron at a glance

The Big “Oncology” Picture Biopsy DX Imaging Surgery Chemotherapy Radiation Cancer Patient Imaging Chemotherapy Life-long follow up imaging Radiation could be delivered as External Beam RT or Brachytherapy (LDR, PDR or HDR) Pre-Treatment Imaging Treatment Planning Treatmment Delivery & Imaging Post-Ttreatment Imaging

Brachytherapy is a highly focal therapy
Derives from the Greek word ‘brachy’ – meaning short-distance
Placing a radiation source internally, either into or immediately next to the tumor, allowing precise radiation dose delivery 1
1. Stewart AJ & Jones B. In Devlin Brachytherapy: Applications and techniques. 2 007. Brachytherapy works ‘ from the inside, out’ External Beam therapy works ‘ from the outside, in’

Evolution continues Flexitron 1982 1983 1986 Evolution continues 1975 1994 First µ-processor digital LDR First Brachyplanning PC First cervix ring applicator First µ-processor digital HDR First digital interstitial LDR First digital HDR with dummy First digital PDR First IBU First Intravascular brachy First simultanuous ch selector First locked ovoid applicator First locked to prostate template First AL 3 drive stepping system First dual source Innovation continues 1975 1981 1981 1982 1983 1986 1989 1991 1992 2007 2007 2008 2009 2009

Brachytherapy has multiple patient benefits across different tumor sites: today’s focus is on prostate 1. . Pötter R. Radiother Oncol 2009;91:141-146 2. Ferrer M, Suarez JF, Guedea F et al. Int J Radiat Oncol Biol Phys , 2008; 72(2): 421–32. 3. Hoskin PJ & Bownes P, Semin Radiat Oncol 2006;16(4):209-17. 4. Pisansky TM, Gold DG, Furutani KM et al . Mayo Clin Proc 2008;83(12):1364-72. 15 American Brachytherapy Society. 26 Polgar C, Major T, Fodor J, et al. Int J Radiat Oncol Biol Phys 2004;60(4):1173-81. 37 Arthur DW & Vincini, FA. J Clin Oncol 2005;23(8):1726-35. 78 Guix B, Finestres F, Tello J et al . Int J Radiat Oncol Biol Phys 2000; 47:95-102. 9. Musmarcher J . Jnl Clin Oncol 2006 ; 24(18S):15543.

Experts support Brachytherapy Prostate BT provides superior PSA control over EBRT in patients with low-risk and selected intermediate-risk prostate cancers. Until the results of randomized studies comparing BT with either EBRT or surgery are available within the next decade, nonrandomized comparative studies can provide the yardstick by which patients and physicians can make informed decisions about which treatment is likely to best suit them. For many, that will be prostate BT. (Vaginal Brachytherapy) VBT is effective in ensuring vaginal control, with fewer gastrointestinal toxic effects than with EBRT. VBT should become the standard of care for women with endometrial cancer of intermediate and high-intermediate risk.

Prostate BT can be given as LDR (“seeds”) or HDR
LDR: Low Dose Rate with radioactive seeds (Iodine-125) implants
Parent method of Brachytherapy
Manual to automatic placement
Loose seeds (rice kernel)=> stranded seeds
HDR: High Dose Rate with one moving source with high activity
Needs an afterloader to remotely send the source into the body
Iridium-192 (3.5 * 0.6 mm) 370 GBq

Nucletron’s Prostate Solution with new 3D integrated realtime ultrasound

Off-line MR Image: Fusion with real-time Ultrasound in OR

Contouring the tumor

Insertion into the prostate

Evaluation of the treatment plan

SeedSelectron is a robotic seed placement device
Adjustment knob
Delivery tube
Compose element
Cartridges and Drive Wire

SeedSelectron
The seedSelectron performs
QA of the seeds
Composition of the seed train, seeds & spacers
Insertion of the seed train
Retraction of the needle

Animation of robotic seed placement (SeedSelectron)

SeedSelectron in a clinical setting

Needles insert ion SeedSelectron setup Treatment Delivery

192 Ir tungsten container HDR treatment requires automated remote afterloading: Microselectron or Flexitron afterloaders

Source A Source B Test source HDR: Ir-192 source through the catheters to treat after testing for obstructions in the catheters Test Treat Test Test Treat Test Treat Test Treat Treat 1 2 3 4 5

Everyday we are bombarded with COMPLEXITY

The Art of Simplicity “ ” Apple believes in one thing – FOCUSED SIMPLICITY . We are a $30B company with less than 30 products. In product design and business strategy, subtraction often adds value . A designer knows he has achieved perfection not when there is nothing more to add, but when there is nothing to take away. - Steve Jobs

Our innovations focus on a safe, fast and simple treatment SPEED SIMPLICITY SPECIFICITY Reduce treatment times Remove complex set-up S A F E T Y Improve Patient Outcome Early Detection Advanced diagnosis

Single Fraction Monotherapy HDR for prostate cancer First Patient treated Dec 2010

Prostate Brachytherapy Evolution
From: Fully free manual placement of needles and seeds highly depending on the user’s skills
To: Manual placement of needles guided by the software making the treatment less user-dependent
HDR automated delivery by afterloader
LDR automated seed/spacer placement
Next step to automate needle placement under image-guidance
Transforming MRI guided robots for biopsy taking into BT needle placing robots (Nijmegen, Utrecht, PMH, Johns Hopkins)
Allowing for:
Further improvement of optimalization of dose delivery
Delivery of radiation where it matters: the tumor

There is more........ Fully Robotized Minimal Invasive Bladder Surgery using DaVinci Alysis/Rijnstate Ziekenhuis

Health Valley Event Presentatie John Lapré

by Health Valley on Mar 19, 2011

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Health Valley Event Presentatie John Lapré — Presentation Transcript