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MaMaLoc: How To Change Cancer Surgeries With Magnets

MaMaLoc: How To Change Cancer Surgeries With Magnets

A small magnetic device might transform breast cancer surgeries.

In early-diagnosed breast cancers, the correct localization of tumor cells is often a challenge. Therefore, during surgery, doctors have to rely on highly-invasive devices to detect the bulk of malignant cells within the tumor.

MaMaLoc (Magnetic Marker Localization), the winner of the 2016’s edition of the Amsterdam Science and Innovation Awards and the result of a collaboration between The Netherlands Cancer Institute (NKI-AVL) and the University of Twente, is a hassle-free alternative for those invasive surgical devices.

Operating breast cancers: from hooked wires to small magnets

Breast cancer is the most common type cancer in women, accounting annually for nearly 1.7 million deaths, worldwide. However, during the last decades, the implementation of screening programs in asymptomatic women led to a significant increase in survival rates in western countries. These screening programs are essential in detecting tumor cells that have not yet spread to other parts of the body, via the lymph nodes, and thus can be completely removed with surgery.

But since early diagnosed breast tumors are not yet palpable, defining the precise location of the malignant cells during surgical excision is a hard task for surgeons. Until now, the most widely used technique for this purpose has been the wire-guided localization (WGL). Prior to surgery, a wire is hooked into the breast’s unhealthy tissue and, during the operation, surgeons follow the wire to locate the lesion and extract the malignant cells.

The WGL technique is far from being the ideal technique, both to the patient and to the doctors: the removal of healthy tissues or failure to remove the totality of malignant cells are frequent; the placement of the wire is difficult in dense tissues and the wire protrudes from the breast, causing pain to the patient.

However, alternatives are lacking or, when they do exist, are undermined by regulatory barriers. For instance, radioactive localization, the injection of radioactive markers in the malignant tissues, has already proven to be effective but is too expensive and subjected to tight legislation that discourage its application in hospitals.

MaMaLoc: a hassle-free alternative

MaMaLoc might be the ideal substitute in operations rooms. The principles behind the technique are simple: a rice grain-sized magnetic cylinder is implanted in the malignant tissue, prior to surgery. During surgery, and using a magnetic detection platform, doctors can easily locate this cylinder, and, in turn, precisely identify the malignant tissue that surrounds it. MaMaLoc allows doctors to continuously reassess their surgical approach, contrary to what happens with WGL, where only one predefined surgical route is possible. Thus, besides giving clinicians a precise location of the malignant cells within the tissue, MaMaLoc will improve the patient’s cosmetic outcome.

Thus far, the device has been successfully tested in 8 patients, at the NKI, and doctors seem to agree that MaMaLoc is far more convenient than the WGL. Bram Schermers, one of the main responsible for the creation of the MaMaLoc technology at the University of Twente, is cautious to jump into big conclusions, because “in such small groups, evident clinical advantages are impossible to establish”. Bram, hopes that, within 5 years, MaMaLoc will also be used in other cancer types, such as melanoma or head and neck cancer.

There is still a long way to go until MaMaLoc reaches the operation’s tables. “Getting commercial availability is one thing; getting the product into the hands of enthusiastic surgeons and helping patients is another”, Bram Schermers argues. The research team is now setting up larger clinical trials to confirm the benefits of MaMaLoc.

Private Companies funding innovation

Establishing commercial partnerships will allow MaMaLoc to move from the current prototype to a marketable version, a process that involves “the design of scalable production processes, as well as obtaining FDA and CE certification”.

For Bram Schermers, companies are a crucial part in the process of developing and selling medical devices, especially by taking care of the bureaucratic procedures that researchers often face when they want to bring a new product to the market.

“Private companies are one of the key players in translating inventions into something people can, want and are allowed to actually use”, filling the gap between the high-potential products developed in the academic environment and the market, an idea shared by Murray Pratt, dean of the Amsterdam City College.

It is therefore comprehensible that “it may be more difficult to attract private funding if you chose to freely publicize any and all research data that is generated with this private investment”. The case is different for publicly-funded research, though. The Horizon 2020 guidelines, demanding that all scientific research is made freely available, make sense in the eyes of Bram because “publishing scientific research behind a paywall is hurting other researchers and hampering innovation”.


References
Rahusen, F., Bremers, A., Fabry, H., Taets van Amerongen, A., Boom, R., & Meijer, S. (2002). Ultrasound-guided lumpectomy of nonpalpable breast cancer versus wire-guided resection: A randomized clinical trial Annals of Surgical Oncology, 9 (10), 994-998 DOI: 10.1007/BF02574518
Anderson, R., Kimmick, G., McCoy, T., Hopkins, J., Levine, E., Miller, G., Ribisl, P., & Mihalko, S. (2011). A randomized trial of exercise on well-being and function following breast cancer surgery: the RESTORE trial Journal of Cancer Survivorship, 6 (2), 172-181 DOI: 10.1007/s11764-011-0208-4
Medina-Franco, H., Abarca-Pérez, L., García-Alvarez, M., Ulloa-Gómez, J., Romero-Trejo, C., & Sepúlveda-Méndez, J. (2008). Radioguided occult lesion localization (ROLL) versus wire-guided lumpectomy for non-palpable breast lesions: A randomized prospective evaluation Journal of Surgical Oncology, 97 (2), 108-111 DOI: 10.1002/jso.20880
Lovrics, P., Cornacchi, S., Vora, R., Goldsmith, C., & Kahnamoui, K. (2011). Systematic review of radioguided surgery for non-palpable breast cancer European Journal of Surgical Oncology (EJSO), 37 (5), 388-397 DOI: 10.1016/j.ejso.2011.01.018
Postma, E., Koffijberg, H., Verkooijen, H., Witkamp, A., van den Bosch, M., & van Hillegersberg, R. (2013). Cost-Effectiveness of Radioguided Occult Lesion Localization (ROLL) Versus Wire-Guided Localization (WGL) in Breast Conserving Surgery for Nonpalpable Breast Cancer: Results from a Randomized Controlled Multicenter Trial Annals of Surgical Oncology, 20 (7), 2219-2226 DOI: 10.1245/s10434-013-2888-7
Ahmed, M., & Douek, M. (2013). A systematic review and meta-analysis of intra-operative ultrasound versus wire-guided localization in the surgical management of non-palpable breast cancers European Journal of Surgical Oncology (EJSO), 39 (11) DOI: 10.1016/j.ejso.2013.07.212

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