URMC Begins Using New Prostate Cancer-Treatment Technology

October 29, 2001

University of Rochester Medical Center has recently begun using a new computerized medical device developed by its researchers to improve the treatment for prostate cancer.

The software-based device is called PIPER (Prostate Implant Planning Engine for Radiotherapy) and was developed and patented by UR and licensed to RTek Medical Systems LLC, a collaboration between the university and Real Time Enterprises, Inc. of Pittsford. The James P. Wilmot Cancer Center acquired the system several weeks ago and began using it last month.

The PIPER system assists surgeons, radiation oncologists and medical physicists in planning and performing brachytherapy, which is an increasingly popular treatment for prostate cancer. Brachytherapy involves surgically implanting tiny radioactive seeds ? about the size of a grain of rice ? into the prostate to destroy cancer cells over a period of several weeks.

The success of brachytherapy hinges on the placement of the radioactive seeds at precise locations within the prostate to destroy all nearby cancer cells without harming the healthy tissue surrounding the prostate.

The PIPER system uses sophisticated optimization algorithms to help clinicians determine how many seeds are necessary and exactly where to place them within the prostate, an organ about the size of a walnut and located between the rectum and bladder which contributes fluids to semen.

Physicians often use computer programs to help them decide how and where to place the seeds, but this system is revolutionary because of its speed and optimization capabilities. Based on an ultrasound scan of a patient’s prostate and other organs, the PIPER System automatically compiles a computer-optimized radiation treatment plan in less than two minutes.

The system’s advantages are speed and precision, allowing radiation treatment planning to be done in the operating room immediately before surgery, instead of several weeks beforehand as is now standard. A radiation treatment plan created in the operating room just minutes before the procedure is better able to match the anatomy that surgeons actually confront.

“It is a tremendous advantage to be able to plot seed placements using up-to-the-minute images of the prostate,” says surgeon Edward Messing, M.D., chairman of the Department of Urology. He has performed scores of brachytherapy procedures at Strong Memorial Hospital.

“When you enter the operating room, the prostate you see then is never the same as the one you saw a few weeks previously,” Messing says, referring to changes in the size and shape of the organ that can result from patient positioning, hormone therapy and anesthesia. “Using PIPER helps take the guesswork and heavy, time-consuming calculations out of the process. You know exactly where your seeds went and where you want to put the next ones.”

Placement of the seeds with pinpoint precision is difficult because seeds are so small that they are difficult to visualize with ultrasound. The Piper system also helps during the procedure, by providing an interactive, ultrasound interface that allows surgeons to track needle locations and determine seed positions in real time. And, actual seed placements can be adjusted to match the optimized plan.

“The PIPER system allows physicians to tailor the placement of seeds to the individual patient’s prostate based on anatomic information at the time of the procedure in ‘real time.’ This approach improves the therapeutic outcome by optimizing the treatment of the cancer cells while lessening the effects on adjacent organs and minimizing side effects and complications,” says Ralph Brasacchio, M.D., assistant professor of radiation oncology and Co-Director of the Prostate Brachytherapy Program.

PIPER was developed by medical physicist Yan Yu, Ph.D., associate professor of radiation oncology at Wilmot Cancer Center, based upon more than six years of research that has been funded by a variety of sources, including the National Cancer Institute and the Whitaker Foundation. The PIPER system was patented by the University and licensed to RTek.

RTek was formed in September 1999 as a joint venture of the University of Rochester and Real Time Enterprises Inc., a medical software engineering company. Real Time Enterprises developed the commercial software for PIPER and RTek assisted in preparation of the regulatory submissions. RTek Medical Systems is part of an accelerated effort by the UR to commercialize technology developed in its laboratories.

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Leslie White
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