The GTx Program: A multi-functioning team-based approach for cancer therapeutics
By: Jonathon Chio
For many patients, surgery plays a critical role in the diagnosis and treatment of newly-identified tumours. The introduction of novel imaging, robotics, and the emerging era of nanomedicine integrating into the operating room has brought about a great need for multidisciplinary teams that can effectively incorporate these technologies in the surgical environment. At the University Health Network, the TECHNA Research Institute (TECHNA) is focused on advancing surgical technologies to improve health. The Guided Therapeutics (GTx) Program, one of TECHNA’s Five Core Centres of Excellence, is composed of scientists, physicists, image technologists, surgeons, radiologists, and engineers who develop advanced image-guided technologies for the surgical management of cancer. Dr. Jonathan Irish is the Medical Director for the GTx Program and Director of Clinical Faculty for TECHNA. Here we reveal how the collaborative efforts of his multidisciplinary translational research team make a tremendously positive impact on the surgical management of cancer.
Radiation treatment and surgery provide targeted therapy for the treatment of tumors. The GTx Program developed a collaboration between scientists and clinicians from each of these two practices to implement image-guided technologies that support combined therapy with both of these treatment modalities. GTx radiation physicist Dr. Robert Weersink works on linking radiation therapy with surgical imaging and pre-surgical planning techniques. This is accomplished, in part, by comparing a tumour’s size and location as identified surgically versus through imaging, including CT, MRI, and positron emission tomography (PET). Such a comparison is currently under evaluation for mucosal cancers in the head and neck, as these diseases can be difficult to locate accurately due to the low resolution of traditional scanning equipment. Notwithstanding the role of an oncologist in identifying tumour location through imaging, an alternative method is being examined—one that uses the administration of molecular agents to detect tumor location.
Along with Dr. Irish, Drs. Harley Chan, Jason Townsen, and Nidal Muhanna are working on the introduction of novel contrast agents into operating room imaging. Their collaborative work with research groups investigates both liposome- and porphysome-based nanoparticles for imaging and therapy in pre-clinical cancer models, with a plan to go to clinical trial. In collaboration with Dr. Gang Zheng’s and Drs. Jinzi Zheng and Christine Allen’s groups, whose research focuses on the porphysome and liposome nanoparticles, respectively, the GTx team will take advantage of the inherent theranostic characteristic of these nanoparticles (capable of providing both diagnostic and therapeutic properties). Delivery of biocompatible, non-toxic, and multi-functional nanoparticles with a long half-life into tumours will render them visible due to the nanoparticles’ photoacoustic and photonic imaging capabilities, and enable their ablation using photothermal or photodynamic therapy techniques. The use of nanoparticles in the operating room setting will represent a promising breakthrough in theranostics, as they are used in both diagnosing and treating cancer through photoacoustic imaging and photodynamic and photothermal therapies, respectively. Equipped with cutting-edge technology, the GTx Program provides the ideal resources and support to translate the research from pre-clinical studies to clinical use.
In addition to its research on nanoparticles, the GTx program also offers 3D printing solutions for various surgical needs, such as structural reconstruction after tumour removal, prototyping medical devices, and developing surgical phantoms. For example, when performing jaw surgery to remove a tumour from the mandible, the lower jaw bone can be reconstructed by fixing a plate to stabilize autologous bone taken from another part of patient’s body. To facilitate this, 3D printing is combined with CT imaging to generate a model of the patient’s mandible used to fabricate a reconstruction plate prior to surgery. With his engineering background, Dr. Harley Chan is able to design and print personalized disease-free models or perform digital surgery simulating tumour removal from the mandible for 3D printing. This model undoubtedly reduces operation time and anesthetic use, thereby improving patient outcomes and reducing overall healthcare costs.
The introduction of a high-performance and multi-functional team to bring technology-driven innovations to surgery and radiation oncology is beneficial to patient care. The motto of the GTx Program—”To Create, To Innovate, To Translate, To Evaluate and To Educate”—is clearly imprinted in the multidisciplinary GTx team. The research output from the GTx program, including the image-guided navigation platform X-Eyes, is currently used in clinical trials within the GTx OR at Toronto General Hospital. It is also clear that collaboration is the key to success, as the GTx team increasingly incorporates nanomedicine and nanotechnology into the diagnostic and therapeutic paradigm for cancer care. Dr. Irish’s team is an excellent example of the future of biomedical research and surgery, one that avoids “silos” and embraces collaboration and partnership. The GTx Program is a team of individuals from all aspects of science united by the goal of positively influencing patient outcomes through use of innovations in cancer surgery—“a sum that is greater than its parts”.