This document summarizes Dr. Lokesh Viswanath's presentation on current and future research at Kidwai Memorial Institute of Oncology. It discusses advances in cancer diagnostics, therapeutics like drug delivery systems, and areas of future research including non-invasive lymph node imaging, implantable chemotherapy devices, and tracking tumor motion for radiation therapy. The presentation also outlines research on transmitting radiation through moving materials and developing predictive models, hypoxia treatments, and robotic surgical tools.

1. Dr. Lokesh Viswanath M.D
Professor in Radiation Oncology
Kidwai Memorial Institute of Oncology
mail: lokpreeth@gmail.com
Presentation IISC Bosch Cyber Centre –
Indo British Meeting 2014

2. Kidwai Memorial Institute of
Oncology.
http://kmio.org/
 State Govt . Autonomous Institution
 KMIO Regional cancer Centre – Govt of India
 Exclusive Tertiary Centre
 Treatment
 Research
 Education
 18000 new Cancer patients per annum
 Multidisciplinary cancer care

3. Last two decades
Phenomenal advances in Cancer research
 Basic Sciences
 Pharmaceutics
 Diagnostics
 Therapeutics:
 Medical oncology
 Radiation Oncology
 Surgical oncology
 Clinical Research – bench to bedside
 Wider availability
 Cost effective

4. Future needs
and research avenues

5. Diagnostics
Non invasive - Whole body imaging of Lymphatics
channels & lymphnodes
 3 dimensional / functional imaging – MRI / CT scan /
others
 Screening and formulation of specific contrast material
 selective uptake into the lymphatic channels
 Lesser adverse events in clinical use
• nano particle

9. Intra tumoral - interstitial drug
delivery system

10. BASIC CONCEPTS
BSA
1 mtr2
Cisplatin - 100mg /m2
Tumor: 1 cm3 : 0.00147mg / 1.47 gm Pt/ 1470 ngm Pt
Avr Adult
70Kg
Ht: 160 cms
1.73m2
70% water
~ 3800 ngm Pt for 1 cycles
~ 22800 ngm Pt for 6 cycles in 18 weeks

11. Need for implantable Chemotherapy
drug delivery systems
 biodegradable
 Sustained delivery
 Evolving Computer simulation of Invitro and invivo Drug
Diffusion kinetics (similar to Radium /now Iodine seed
Implant principles in Brachytherapy)
 isodose graphs & models
 Evolving principles for Chemo Pellet implantation
 Spacing between pellets
 3 Dimensional simulation of drug diffusion and distribution
and time lapse simulation to study & document overall
tumor dose and its effectiveness in Tumor control

12. Future needs
 Newer formulation – in vitro and animal experiments
 development of computer simulation for implanted
sustained anti cancer drug delivery system - similar to
brachytherapy, implant of permanent radioactive
iodine seeds .

13. g Pt/g
Kroin & penn 1982, RAT BRAIN,micro infusion. 0.9mg/h – 7 days
UPTO 10mm

14. In vitro Tissue Permeation study
of Cisplatin
Total amount of Cisplatin permeated v/s Time
y = 0.0894x - 0.0128
R2
= 0.9968
0.0
0.2
0.4
0.6
0.8
0 5 10
Time in hours
AmountofCisplatininmg
Actual line
Fitted line
CDDP tissue saline
Thickness of the tissue : 0.24mm
The average Permeability constant 0.854 cm / hour (SD =  0.0378)

15. Implantable polymeric devices
 The polymer device is loaded with the desired
chemotherapeutic agent and then implanted
within the tumor, surgically or by special
implanting devices.
 Implantable polymeric systems utilize various
types of polymers and polymeric membranes to
control the release kinetics of drugs from the
delivery systems.
 Polycaprolactone cylinders + Cisplatin (10,20, 30 % Load)

19. Drug release profile of BFL-1,
BFL-2 & BFL-3.
Cumulative Drug Release v/s Time
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
0 5 10 15 20 25 30 35
Time in days
CDRinmg
Average CDR in mg

20. In vitro degradation profile of
Polycaprolactone
 The in vitro degradation
profile showed decrease
in the dry weight of the
polymer indicating slow
surface erosion or
degradation of
Polycaprolactone
cylinders.
 The surface erosion or
degradation may
contribute to the drug
release from the
formulation.
Polymer Degradation in 0.9% Sodium chloride
98.4
98.6
98.8
99
99.2
99.4
99.6
99.8
100
100.2
0 5 10 15 20 25 30
Time in daysweight%ofdegraded
polymerremaining
Trial -1
Trial-2

21. Inflatable spacer for Rectal
displacement in Prostate Cancer

22. Prostate Cancer Radiation therapy

23. Implantable & inflatable spacer
device
 Cancer Prostate
 Rectum- Proximal Dose limiting structure for
Radiation therapy – displaced
 Siliconised

25. Transmission of ionizing radiation
through matter in dynamics
 Computer simulations have demonstrated that
Magnetic field can interfere with ionizing radiation
 Transmission of Ionizing radiation through medium in
motions or fluid in motion is not well studied

26. Experiment
1 cm 3
Field Size : 1 x 1 cms
X rays: 6 – 18 Mv
Electron Beam: 6, 9, 12, 18, 20 Mev
Transmitted
radiation
Thimble
chamber
V 0 - Control
V 2400 rpm: 25 m/sec

29. Future application
 If putting the medium into dynamics can reduce the
intensity of radiation
 Application
 protection of astronauts from space radiation / solar
flares.
 The shielding of radiation inside the space capsule can
by increased by circulating / pumping fluid (water) at
certain velocity
 Therapeutics – Radiation beam intensity can also be
varied and may be of use in future particle beam therapy

30. Technical
Tumour motion Tracking
 Definition of ITV > Targeting a moving Target with
Radiation therapy
 Implantable markers with transmitter or implantable
marker which reflect external RF and Track motion in
3-4 dimensions
 Eg: Solid tumors which move with respiration – Lung
cancer, Liver tumours etc

32. Indigenous low cost Respiratory
gating device for Brest cancer
radiotherapy

33. Radiation Biology
 Computer models & simulations to explain why cancer
cell is sensitive to ionizing radiation in M phase of cell
cycle and resistant in S phase,
 Develop 3D cell models with intracellular components
and their concentration of intracellular material in
various phases of cell cycle, may help in advancing
radiation biology experiments.
 Correlation of clinical onco-therapeutic response with
simulated radiobiology experiments

34. Development of Predictive
normaogram for solid tumours
 Prediction of Response to Onco-therpeutics
 Normograms : Clinical Parameters + Imaging
parameters + Lab parmeters + during treatment
parameters
 Therapy > Response assessment > development of
Normograms
 Use :
 Therapeutic decisions

35. Solid Tumors – Hypoxia
 Development of oxygen carrying nano particles
 Use – Hypoxic cell sensitizer – for radiation therapy

36. Development of Image Guided
mini robotic surgical instruments

37. Thank you