An advanced form of image-guided radiation therapy, known as intensity modulated proton therapy (IMPT), has shown early promise for the treatment of recurrent lung cancer, according to new research from The University of Texas MD Anderson Cancer Center. Researchers found that after re-irradiation with IMPT, the majority of patients were free from local recurrence one year following treatment and few experienced severe side effects.

The data, presented at the 2017 Multidisciplinary Thoracic Cancers Symposium, is the first to analyse re-irradiation of thoracic cancers with IMPT and offers hope for a patient population with few curative treatment options.

Lung cancer is the leading cause of cancer death in the U.S. According to the American Cancer Society, more than 222,500 people will be diagnosed and 155,870 will die from the disease in 2017, with recurrence the primary cause of death in these patients.

As many recurrent lung cancer patients are not candidates for surgery, and response rates to second-line chemotherapy are poor, there’s been growing interest in the repeat use of radiation, explained Jennifer Ho, M.D., resident, Radiation Oncology.

‘Historically, repeat radiation at a higher, curative dose was not possible with older, less precise radiation techniques because the cumulative radiation dose necessary to treat the cancer would cause too much toxicity,’ said Ho, the study’s lead author. ‘In lung cancer, tumours are close to the oesophagus, aorta and spinal cord, and all of these critical structures are vital for the body to function. The proton beam – and pencil beam in particular — provides much more conformal radiation, which means higher doses to tumours and lower dosages to critical structures nearby.’

IMPT, one of the most advanced forms of proton therapy, is based on scanning beam technology that can simultaneously optimize intensities and energies of all pencil beams to deliver a precise dose of protons to tumours, explained Joe Y. Chang, M.D., Ph.D., professor, Radiation Oncology.

‘The technology has the ability to destroy cancer cells while sparing surrounding healthy tissue from damage. Therefore, important quality of life outcomes can be preserved and severe toxicities have shown to be reduced,’ said Chang, the study’s corresponding author.

For the single-institution study, the researchers retrospectively analysed 27 patients who received IMPT for a lung cancer recurrence between 2011 and 2016. All patients had received a prior thoracic radiation course with curative intent. Of the cohort, 22 (81 percent) were treated for non-small cell lung cancer. The median time to re-irradiation after initial treatment was 29.5 months.

At a median follow-up for all patients of 11.2 months – and 25.9 months for those still alive – the median overall survival (OS) was 18 months, with one year OS at 54 percent. Four patients (15 percent) experienced a local failure (LF), recurrence within the re-irradiation field; 78 percent of patients did not experience a LF within the first two years of follow-up. At one year, 61 percent of patients were free from recurrence in the chest and lung, and progression-free survival was 51 percent.

Of particular interest to the researchers, patients who received a higher dose of radiation had fewer local recurrences and improved progression-free survival.

Re-irradiation was well-tolerated, with two patients experiencing grade three pulmonary toxicity and none with severe oesophageal toxicity. No patients experienced grade four or five toxicities. Historically, re-irradiation of the lung was associated with moderate to severe toxicity, even fatal, toxicities in 20 to 30 percent of patients.

‘With the advancement of IMPT, we knew that we were able to generate more precise radiation treatment plans that spared normal tissue, but we weren’t sure if this would translate into beneficial clinical outcomes until we analyzed this data,’ said Chang. ‘While the findings are early, we’re hopeful that we can offer more positive outcomes and low toxicity with IMPT for recurrent thoracic cancer patients who previously had few treatment options.’

Limitations of the study include its small size and retrospective data. Reirradiation with IMPT in other disease sites is an area of continued research interest; studies in head and neck cancer are ongoing at MD Anderson.

MD Anderson Cancer Institute www.mdanderson.org/newsroom/2017/03/advanced-form-of-proton-therapy-shows-promise-for-treating-lung-cancer.html

In an important step toward endoscopic diagnosis of cancer, researchers have developed a handheld fibre optic probe that can be used to perform multiple nonlinear imaging techniques without the need for tissue staining. The new multimodal imaging probe uses an ultrafast laser to create nonlinear optical effects in tissue that can reveal cancer and other diseases.

Today, cancer is typically diagnosed by removing a bit of tissue with a biopsy and then sending that tissue to a specially trained pathologist who stains the tissue and uses a microscope to look for cancerous cells. The ability for doctors to skip the biopsy and use a multimodal imaging endoscope to diagnose cancer on the spot would save valuable time and could also allow surgeons to more easily differentiate between cancerous and healthy tissue during surgery.

With the new probe, imaging techniques that previously required bulky table-top instruments can be performed with a handheld device measuring only 8 millimeters in diameter, about the same diameter as a ballpoint pen. If miniaturized further, the probe could easily be integrated into an endoscope for nonlinear multimodal imaging inside the body.

‘We hope that, one day, multimodal endoscopic imaging techniques could help doctors make quick decisions during surgery, without the need for taking biopsies, using staining treatments or performing complex histopathological procedures,’ said Jurgen Popp, from Leibniz Institute of Photonic Technology in Jena, Germany and the paper’s lead author.

It is the first miniaturized probe for multimodal biological imaging to incorporate a multicore imaging fibre, a type of optical fibre consisting of several thousand light-guiding elements. This special imaging fibre allowed the researchers to keep all moving parts and electric power outside of the probe head, making the probe easy and safe to use in the body.

The researchers have tested the probe with many types of tissue samples, but because it is currently designed for forward view mode, the primary applications of the probe would likely include skin, brain or head and neck surgery. They are working on implementing a side view mode that could be used to investigate hollow organs and arteries such as the colon, bladder or aorta.

‘The new probe serves as a miniaturized microscope that uses near-infrared lasers to investigate tissue,’ said Popp. ‘Different components of biological tissue react differently to the excitation lasers, and their unique response gives us information about the molecular composition and morphology within the tissue.’

The handheld multimodal imaging probe can simultaneously acquire several types of images: coherent anti-stokes Raman scattering, second harmonic generation and two-photon excited auto-fluorescence. These nonlinear imaging techniques have been shown to be useful for clinical diagnostics, including identifying cancerous cells, but it has been difficult to miniaturize the required instrumentation for use inside the body.

The probe’s reduced size comes from its use of gradient index, or GRIN, lenses to focus the laser light. Compared to traditional spherical lenses that use complicated shaped surfaces to focus light, GRIN lenses can be made very small because they focus light through continuous refractive index changes within the lens material. Popp’s research team collaborated with scientists from Grintech Gmbh who designed GRIN lenses only 1.8 millimetres in diameter and helped incorporate the robust lens assembly into a small aluminium housing.

The Optical Society
http://www.osa.org/en-us/about_osa/newsroom/news_releases/2017/new_fiber_optic_probe_brings_endoscopic_diagnosis/

A multidisciplinary group that includes the University of Illinois at Urbana-Champaign and the University of Washington at Tacoma has developed a novel platform to diagnose infectious disease at the point-of-care, using a smartphone as the detection instrument in conjunction with a test kit in the format of a credit card. The group is led by Illinois Electrical and Computer Engineering  Professor Brian T. Cunningham; Illinois Bioengineering Professor Rashid Bashir; and, University of Washington at Tacoma Professor David L. Hirschberg, who is affiliated with Sciences and Mathematics, division of the School of Interdisciplinary Arts and Sciences.
Findings have demonstrated detection of four horse respiratory diseases, and in Biomedical Microdevices, where the system was used to detect and quantify the presence of Zika, Dengue, and Chikungunya virus in a droplet of whole blood. Project collaborators include Dr. David Nash, a private practice equine expert and veterinarian in Kentucky, and Dr. Ian Brooks, a computer scientist at the National Center for Supercomputing Applications.
The low-cost, portable, smartphone-integrated system provides a promising solution to address the challenges of infectious disease diagnostics, especially in resource-limited settings or in situations where a result is needed immediately. The diagnostic tool’s integration with mobile communications technology allows personalized patient care and facilitates information management for both healthcare providers and epidemiological surveillance efforts. Importantly, the system achieves detection limits comparable to those obtained by laboratory-based methods and instruments, in about 30 minutes.
A useful capability for human point-of-care (POC) diagnosis or for a mobile veterinary laboratory, is to simultaneously test for the presence of more than one pathogen with a single test protocol, which lowers cost, saves time and effort, and allows for a panel of pathogens, which may cause similar symptoms, to be identified.
Infectious diseases remain the world’s top contributors to human death and disability, and with recent outbreaks of Zika virus infections, there is a keen need for simple, sensitive, and easily translatable point-of-care tests. Zika virus appeared in the international spotlight in late 2015 as evidence emerged of a possible link between an epidemic affecting Brazil and increased rates of microcephaly in newborns. Zika has become a widespread global problem—the World Health Organization (WHO) documented last year that since June 2016, 60 nations and territories report ongoing mosquito-borne transmission. Additionally, since Zika virus infection shares symptoms with other diseases such as Dengue and Chikungunya, quick, accurate diagnosis is required to differentiate these infections and to determine the need for aggressive treatment or quarantine.
The technology is intended to enable clinicians to rapidly diagnose disease in their office or in the field, resulting in earlier, more informed patient management decisions, while markedly improving the control of disease outbreaks. An important prerequisite for the widespread adoption of point-of-care tests at the patient’s side is the availability of detection instruments that are inexpensive, portable, and able to share data wirelessly over the Internet.
The system uses a commercial smartphone to acquire and interpret real-time images of an enzymatic amplification reaction that takes place in a silicon microfluidic chip that generates green fluorescence and displays a visual read-out of the test. The system is composed of an unmodified smartphone and a portable 3D–printed cradle that supports the optical and electrical components, and interfaces with the rear-facing camera of the smartphone.
The software application operating on the smartphone gathers information about the tests conducted on the microfluidic card, patient-specific information, and the results from the assays, that are then communicated to a cloud storage database.
Dr. Nash observes that, “This project is a game changer. This is the future of medicine—empowered front-line healthcare professionals. We can’t stop viruses and bacteria, but we can diagnose more quickly. We were able to demonstrate the clear benefit to humankind, as well as to animals, during the proposal phase of the project, and our results have proved our premise.

University of Illinois
mntl.illinois.edu/news/article/23759

• Peripheral neuropathy is a very common side-effect of chemotherapy and may eventually lead to early discontinuation of treatment.
• Collaboration between research and industry led to the identification and successful testing of a new molecule capable of preventing this neurological complication.
• This molecule could potentially become the first existing treatment to prevent this frequent adverse effect and improve the quality of life of cancer patients.

IDIBELL Researchers of the Neuro-Oncology Unit of Bellvitge University Hospital – Catalan Institute of Oncology, led by Dr. Jordi Bruna, have successfully tested a new molecule capable of preventing the development of peripheral neuropathy induced by chemotherapy in cancer patients, especially in colon cancer cases, the third most common neoplasm in the world. The molecule, which has a completely novel mechanism of action, would be the first treatment against this neurological complication, for which no effective treatment has yet been approved.
One of the main adverse effects of certain chemotherapeutics used in the treatment of cancers is peripheral neuropathy, which can cause tingling, numbness, pain or alterations in the functionality of patients, among others. This complication, so far, has been regarded as a “price to pay” despite having a demonstrated negative impact on the quality of life of the patient, increasing their care expenses and often preventing the complete and effective administration of  the cytostatic treatment, with the potential decrease of survival chances that entails.
Researchers at the HUB-ICO-IDIBELL Unit identified a new molecule – developed by the Catalan laboratory Esteve – as a candidate to prevent the onset of this adverse effect. "Through a public-private partnership, we have been able to design a Phase 2b clinical trial (randomized with placebo), which has allowed us to get a great deal of scientific information – effect on pain, pathophysiology – and draw conclusions as to the potential of the drug in the prevention of neuropathies during cytostatic treatment”, explains Dr. Bruna, who led the trial.
The results of the study prove a decrease in the appearance of disorders associated with nerve dysfunction in those cancer patients who took the new drug. "When the trial was designed, safety data from the previous trials limited the duration of treatment with the new molecule and this meant that we had to work at low doses in relation to the duration of the chemotherapy treatment, but we have nevertheless obtained positive results and now we have enough information to be able to extend the duration of the treatment. Therefore, we hope to obtain even more satisfactory results" the IDIBELL researcher comments.
"Given the usual pace of clinical trials and drug agencies following fast-track approval processes in severe or orphan pathologies, this new drug could potentially reach the market soon, since it would be the first available treatment to avoid this type of neuropathy. In addition, it has other medical uses as a non-opioid analgesic”, adds Bruna. In any case, improving pain control and reducing the occurrence of severe neuropathy is undoubtedly the most prominent benefit of the development of this novel drug..
IDIBELL
www.idibell.cat/modul/news/en/1024/researchers-prove-the-effectiveness-of-a-new-drug-to-prevent-the-onset-and-the-pain-of-chemotherapy-induced-neuropathy

During operations, it can be difficult for surgeons to avoid severing crucial nerves because they look so much like other tissue. A new non-invasive approach that uses polarized light to make nerves stand out from other tissue could help surgeons avoid accidentally injuring nerves or assist them in identifying nerves in need of repair.
Although nerve injuries are a known complication for many types of surgery, surgeries involving the hand and wrist come with a higher risk because of the dense networks of nerves in this area. There are a few techniques available to help doctors identify nerves, but they have various limitations such as not providing real-time information, requiring physical contact with the nerve or requiring the addition of a fluorescent dye. 
Cousins, Kenneth and Patrick Chin, developed the idea independently from any institute to use an optical technique known as collimated polarized light imaging (CPLi) to identify nerves during surgery. Kenneth later joined a research group led by Thomas van Gulik, a surgeon at the Academic Medical Center, and brought along a working prototype which has been further developed into a practical system that can be deployed in the operating room.
In The Optical Society (OSA) journal Biomedical Optics Express, the researchers report that a surgeon using CPLi technology was able to correctly identify nerves in a human hand 100 percent of the time, compared to an accuracy rate of 77 percent for the surgeon who identified nerves using only a visual inspection.
CPLi uses a polarized beam of light to illuminate the tissue. When this light passes through a nerve, the tissue’s unique internal structure reflects the light in a way that is dependent on how the nerve fibre is oriented compared to the orientation of the polarization of the light. By rotating the light’s polarization, the reflection appears to switch on and off, making the nerve tissue stand out from other tissue. For this application, it was important to use light that was collimated, meaning all the light waves were parallel to each other, to maximize the amount of light reflected by the tissue.
“We adapted the optics used for CPLi so that they could be incorporated in a surgical microscope, which can be placed above the surgical area,” said Kenneth Chin. “The resulting system can be used in a wide range of surgical fields where superficial nerves need to be identified.”
After testing their technique on animal tissue, the researchers used it to examine 13 tissue sites from the hand of a human cadaver. A surgeon looked for nerve tissue at these sites by eye under typical surgical illumination while a different surgeon used CPLi for an independent assessment. Histological evaluation was then used to verify the presence of nerve tissue at each site. The surgeon using visual inspection correctly identified nerve tissue in 10 of the 13 cases while the surgeon using CPLi correctly identified nerve tissue in all cases.
With patient consent, the researchers also used CPLi to successfully identify nerve tissue during a procedure to relieve pain in the wrist. They plan to do additional tests of the technique during live surgery to better understand how the optical reflection of nerves might vary among patients and under various surgical conditions. 

The Optical Society
www.osa.org/en-us/about_osa/newsroom/news_releases/2017/new_tool_aims_to_make_surgery_safer_by_helping_doc/