Cutting-edge technologies at the heart of the radiosurgery revolution
Radiotherapy Big data, and the ability to personalise treatment plans, are shaping current developments in stereotactic radiosurgery.
Brainlab has been dedicated to innovation and best practice in the fields of surgery, radiotherapy, medical image sharing and digitally integrated O.R.s since 1989.
Over the last 10 years, beam-shaping and targeting technologies have heavily impacted the field of stereotactic radiosurgery, which involves focused radiation to ablate tumours.
“For the future, there are a number of challenges,” says Stefan Vilsmeier, CEO of Brainlab, which specialises in this area.
The challenges begin with the cancer patient himself, who may be expected to undergo a number of different treatments – such as immunotherapy, chemotherapy, radiotherapy and possibly surgery – as part of a care plan. This is in contrast to past scenarios, where there may have been only one or two treatments available.
“There is a big challenge in how you can effectively embed a particular treatment – such as radiosurgery – in the chain of all the different treatments that are going to occur,” says Vilsmeier.
"Cancer is becoming more of a chronic than a fatal disease"
“Cancer is becoming more of a chronic than a fatal disease, which has implications for what treatment planning technologies are used. First and foremost, we need treatments that are focused on the quality of life of patients.
“So, for example, when dealing with brain tumours, ensuring the maximum possible cognitive capacity of patients post-surgery is critical.
“At Brainlab, we’re looking at measuring the patient’s cognitive capacity post-treatment, as well as how we can further prevent any damage to those areas that are critical for memory formation, etc.
“As patients live longer, there’s also a likelihood that a single patient will experience further metastases.
“We recently introduced software that allows you to treat multiple brain metastases in parallel. And so, new studies show that patients have the same prognosis whether they have 3-5 or 10 metastases.
“That obviously changes the paradigm for how patients are being treated.”
Vilsmeier sees developments in big data playing a major role in how treatment plans are developed – with an emphasis on personalisation to the patient.
“Today, patients maybe receive a particular treatment depending on the size of the tumour; it is not always possible to fully take into account other factors, such as the genetic sub-type of the primary tumour, the location and shape of the tumour, the supply of oxygen to it, and so on.
"Everybody is talking about big data"
“With more sophisticated ways of collecting information, we are going to be able to customise a treatment for each patient, and become better at predicting which treatment will be most effective for each patient.
“We created a unique project with the American Association of Neurological Surgeons and the American Society of Radiation Oncology – a registry with accumulated data on thousands of patients, looking at every treatment they had undergone and the follow-up.
“So, we’re considering all the different combinations of treatments and their success for different categories of patient, and we will get data that will really help to personalise a care path for the individual patient’s situation.”
Anatomy of change
“Everybody is talking about big data,” Vilsmeier continues, “but in a medical context, most people are only looking at genetic information and other lab data, because these are the only things available.
“In radiosurgery, the challenge is to take volumetric and anatomical information into account – and we have come up with a technology where you can upload a complete treatment plan and, at the same time, such data would be mined and analysed in the background.
“It’s similar to scanning in a document and then using optical character recognition software. All of a sudden, more data is available – you can search the document.
“When you use a CT scan or an MRI scan in conjunction with our software, you will be able to find more data related to particular features or abnormalities.
"When you have data from many different sites available to individual hospitals, you can ensure more standardised care"
“Currently, to account for all different treatment options for brain metastases, you would have to consult and start dozens of clinical trials, whose data may be partially obsolete by the time they are published, to find particular information relevant to your patient.
“But with software that pools data continuously from multiple institutions, you will be able to see all the subsets of data and reactions to treatment that may be relevant. A lot more information is being fed into the process – and it is more readily accessible.”
Ultimately, this will enable doctors to make better decisions about the use of radiotherapy and surgery in a particular patient care plan.
“When you have data from many different sites available to individual hospitals, you can ensure more standardised care,” says Vilsmeier. “This ties back to our vision to increase access to better care and increase treatment consistency.”