Company Established To Commercialize University's Cancer-Treatment Technology

December 21, 1999

The University of Rochester has joined with Real Time Enterprises, a Pittsford software engineering firm, to commercialize technology aimed at improving a common prostate cancer procedure called brachytherapy. The new company, RTek Medical Systems LLC, brings together the expertise of medical physicists, radiation oncologists and surgeons from the University's Medical Center with the knowledge of software experts from Real Time Enterprises.

The goal of the partnership is to transform the University's basic research into technology that surgeons could use in brachytherapy procedures, where tiny radioactive seeds are implanted into the prostate.

RTek will focus on the development of treatment planning systems to help physicians who perform brachytherapy procedures deliver radiation so that it destroys cancer cells in the prostate while keeping other vital organs intact. Brachytherapy is an increasingly popular procedure for treating the nearly 200,000 men each year who are diagnosed with cancer of the prostate, which is an organ about the size of a small peach between the rectum and bladder that contributes fluids to semen. In addition to brachytherapy, where radioactive seeds destroy cancer cells in the organ over several weeks, treatment options include hormone therapy, surgery, and external radiation.

At the heart of the company's technology is a sophisticated planning system based on genetic algorithms originally developed by medical physicist Yan Yu, Ph.D., associate professor of radiation oncology. Yu is a well-known expert on radiation treatment planning who heads a task force on the subject for the American Association of Physicists in Medicine; he also serves as director of technology for RTek.

Medical physicists like Yu play an often unseen role in cancer treatment, ultimately deciding how to deliver radiation to best eradicate cancerous tissue or organs without hurting healthy tissue. In cases of prostate cancer, the stakes are very high: the bladder, rectum, urethra, and nerves that control sexual function are all packed together near the organ, making it an especially challenging disease to treat. Brachytherapy is a little bit like baking a single muffin from the inside out, with physicists and physicians trying to ensure that every bit of the "muffin" is cooking at the exact same temperature while the other muffins nearby stay cool.

Choosing the right pattern for the seeds, which are radioactive particles about the size of a grain of rice, is daunting. Physicians commonly turn to commercial programs to help them decide how to place the particles. The recommended treatment plan is put in the hands of a surgeon, who actually inserts several dozen seeds into the prostate during a one- or two-hour surgical procedure.

Yu's work, dubbed PIPER for Prostate Implant Planning Engine for Radiotherapy, uses artificial-intelligence technology to recommend a radiation treatment plan. Based on an ultrasound scan of a patient's prostate and other pelvic organs, PIPER sets up a competition between the possible configurations, and in just two minutes presents to physicists and physicians the "winner"-the plan that the program decides is most likely to work best.

The speed of PIPER, whose underlying technology has been patented by the University, may make it possible to do the radiation planning right in the operating room immediately before surgery, instead of several weeks beforehand as is now standard. That's a tremendous advantage, says surgeon Edward Messing, M.D., chair of the Department of Urology, who has performed scores of brachytherapy procedures at Strong Memorial Hospital.

"The prostate you see in the operating room is never the same one you saw three weeks previously in your office," says Messing. "Hormone therapy before surgery can shrink the prostate, for instance, and even anesthesia can change the positioning of the pelvis the day of surgery. This oftentimes makes deviations from the now-dated plan necessary during surgery." RTek's goal is to make the process more precise. With a radiation treatment plan compiled just minutes before the operation, the plan is more likely to match what physicians actually confront in the operating room.

The new treatment planning system must be tested rigorously before any application for marketing approval will be submitted to the U.S. Food and Drug Administration, and the FDA must approve any product before it would become available. At the University, the FDA has approved a clinical trial of the current system as an investigational device on about 30 patients. Messing, Yu and their colleagues will study the radiation treatment plans recommended by the system, along with the effects on tumor control, quality of life, and complications in patients who get the PIPER treatment compared to patients who receive a commercially available treatment. The clinical study will build on more than five years of basic research that has been funded by a variety of sources, including the National Cancer Institute and the Whitaker Foundation.

New product development and support is part of the expertise that Real Time Enterprises (RTE) brings to the partnership. The company specializes in software for medical equipment and devices like blood pressure monitors, vision screeners, and other diagnostic equipment used around the world. Currently RTek is renting space in RTE's facilities in the Tobey Village Office Park in Pittsford.

"This line of research really is compelling," says RTE President Robert Ruppenthal. "People who treat cancer are visibly excited and impressed by the potential of this technology, because it's so different from what's out there today. Current treatment planning tools are trial and error: They will tell a physician what dose a given seed distribution will deliver, but they will not tell the doctor where to put the seeds."

RTek is the result of an accelerated effort by the University to commercialize technology developed in its laboratories. "There are many exciting technologies being developed in the Medical Center and across the entire University," says Jay Stein, M.D., senior vice president and vice provost for Health Affairs at the University, and CEO of the Medical Center and Strong Health. "This is one of the first of what we expect to be an ongoing series of technologies we plan to commercialize."

Genetic Algorithms for Treating Cancer

Researchers are sending forth strings of binary digits to go forth and multiply-all in the name of human health.

Using strands of 0s and 1s to stock a digital community, complete with mating, offspring, and the occasional mutation, is nothing new to scientists who create genetic algorithms. These mathematical formulas are governed by Darwin's "survival of the fittest" mantra and rely on the principles of evolution to create solutions in a variety of applications, including financial analyses, computer-assisted scheduling, and target detection for the military.

Now scientists are beginning to explore use of the formulas in treating cancer.

Yan Yu and colleagues created a digital community with 64 "members" whose binary codes each represent a different radiation pattern. Community members compete to pass on their "genetic material"-bits of binary code-to the next generation. Each pattern's viability is determined by mathematical criteria which favor radiation plans that irradiate the prostate efficiently and knock out cancerous cells while sparing vital organs. In a game of virtual natural selection, binary code that embodies these qualities survives and multiplies, while poor code perishes.

Over the course of 200 generations the community evolves, with codes coming together randomly, combining their genetic material, and even mutating occasionally. In this way, the genetic algorithm creates a huge range of potential solutions that it constantly sifts to find the best candidate for a treatment plan.

"A genetic algorithm can look at a much greater range of options than we otherwise could. There might be certain combinations that would never occur to a physicist to try," says Yu. In dozens of simulated tests, Yu's algorithm "killed" more cancer cells and applied the radiation more efficiently than conventional methods, while still sparing nearby vital organs like the urethra, bladder and rectum.

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