Guest Director's Update
New Center Explores Imaging Technologies for Localized Cancer Treatments
Dr. Bradford Wood
Director, NIH Center for Interventional Oncology
The new Center for Interventional Oncology (CIO) was established earlier this year at the NIH Clinical Center (CC) to develop and translate image-guided technologies for localized cancer treatments. The Center is a collaboration involving the CC, NCI, and the National Heart, Lung, and Blood Institute (NHLBI). The Center will draw on the strengths of each institute to investigate how imaging technologies and advanced devices can diagnose and treat localized cancers in ways that are precisely targeted and minimally or non-invasive. It will also help bridge the gap between diagnosis and therapy, and between emerging technology and procedural medicine.
Advanced imaging methods have ushered in an era of earlier detection of cancers that are frequently localized to a single organ or region. Interventional oncology often provides cancer patients with local or regional treatment options to augment the standard cancer treatment options: systemic chemotherapy, surgery, and radiation.
CIO investigators will leverage the interdisciplinary, translational environment at the CC to investigate and optimize how and when to combine drugs, devices, and multimodal imaging navigation. For example, "activatable" drugs can be injected in a vein or artery, then deployed directly in the tumor with needles or catheters using "medical GPS"—a technique that enables the physician to navigate through the body with real-time visualization using the latest advanced imaging technologies, such as magnetic resonance imaging (MRI), positron emission tomography (PET), computed tomography (CT), or ultrasound.
Images captured earlier can be reused to guide devices delivering targeted therapy to the location of the disease, making the procedure more cost-effective because it doesn't require the system used to record the first image to be physically present. A prior prostate MRI, for example, can be used to help with guided biopsy or focal ablation by using a "medical GPS"-enabled needle and ultrasound, without tying up an MRI system during the procedure.
In another example, a thin needle or sound waves can be used to ablate tumors and enhance targeted drug delivery. Energy sources include high-intensity focused ultrasound, freezing, microwaves, laser, and radiofrequency.
Researchers will also expand investigations into image-guided drug delivery or image-guided "dose painting," where the image can be used to prescribe a particular drug dose to a specific region, by combining targeted, activatable drugs with localized energy or heat to deploy the drug within specially engineered nanoparticles.
The Center will provide a forum to encourage collaborations among researchers and patient-care experts in medical, surgical, urologic, and radiation oncology and interventional radiology. The CC provides an exceptional environment for this type of collaborative translational research and patient care.
Other major program components will include the development of new image-guided methods for personalized drug investigations (or tracking tissue responses to investigational drugs during drug discovery) and first-in-human investigations involving new drugs, devices, image-guided robotic assistance, molecular probes, and nanoparticles.
Many oncologists are not currently familiar with, nor trained in, image based, localized treatment approaches. At the same time, interventional radiologists may lack formal training in oncology. Therefore, education and cross-training will be another important part of the program.
The CIO's collaborative activities will be guided by a steering committee that comprises two NCI appointees, one appointee from NHLBI, and another from the CC. The panel is led by Dr. David Bluemke, director of the Clinical Center’s Radiology and Imaging Sciences Department.
It's with great excitement that I direct this new program, as it is ideally and uniquely positioned to provide an interdisciplinary environment that combines training, patient care, and translational research to accelerate progress in interventional oncology and molecularly targeted interventions.