Marco Ferrari1, Michael J Daly2, Catriona M Douglas3, Harley H L Chan2, Jimmy Qiu2, Alberto Deganello4, Stefano Taboni4, Carissa M Thomas5, Axel Sahovaler5, Ashok R Jethwa5, Wael Hasan5, Piero Nicolai4, Ralph W Gilbert5, Jonathan C Irish6. 1. Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada. 2. Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada. 3. Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada. 4. Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy. 5. Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada. 6. Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada. Electronic address: jonathan.irish@uhn.ca.
Abstract
OBJECTIVES: To demonstrate and quantify, in a preclinical setting, the benefit of three-dimensional (3D) navigation guidance for margin delineation during ablative open surgery for advanced sinonasal cancer. MATERIALS AND METHODS: Seven tumor models were created. 3D images were acquired with cone beam computed tomography, and 3D tumor segmentations were contoured. Eight surgeons with variable experience were recruited for the simulation of osteotomies. Three simulations were performed: 1) Unguided, 2) Guided using real-time tool tracking with 3D tumor segmentation (tumor-guided), and 3) Guided by 3D visualization of both the tumor and 1-cm margin segmentations (margin-guided). Analysis of cutting planes was performed and distance from the tumor surface was classified as follows: "intratumoral" when 0 mm or negative, "close" when greater than 0 mm and less than or equal to 5 mm, "adequate" when greater than 5 mm and less than or equal to 15 mm, and "excessive" over 15 mm. The three techniques (unguided, tumor-guided, margin-guided) were statistically compared. RESULTS: The use of 3D navigation for margin delineation significantly improved control of margins: unguided cuts had 18.1% intratumoral cuts compared to 0% intratumoral cuts with 3D navigation (p < 0.0001). CONCLUSION: This preclinical study has demonstrated the significant benefit of navigation-guided osteotomies for sinonasal tumors. Translation into the clinical setting - with rigorous assessment of oncological outcomes - would be the proposed next step.
OBJECTIVES: To demonstrate and quantify, in a preclinical setting, the benefit of three-dimensional (3D) navigation guidance for margin delineation during ablative open surgery for advanced sinonasal cancer. MATERIALS AND METHODS: Seven tumor models were created. 3D images were acquired with cone beam computed tomography, and 3D tumor segmentations were contoured. Eight surgeons with variable experience were recruited for the simulation of osteotomies. Three simulations were performed: 1) Unguided, 2) Guided using real-time tool tracking with 3D tumor segmentation (tumor-guided), and 3) Guided by 3D visualization of both the tumor and 1-cm margin segmentations (margin-guided). Analysis of cutting planes was performed and distance from the tumor surface was classified as follows: "intratumoral" when 0 mm or negative, "close" when greater than 0 mm and less than or equal to 5 mm, "adequate" when greater than 5 mm and less than or equal to 15 mm, and "excessive" over 15 mm. The three techniques (unguided, tumor-guided, margin-guided) were statistically compared. RESULTS: The use of 3D navigation for margin delineation significantly improved control of margins: unguided cuts had 18.1% intratumoral cuts compared to 0% intratumoral cuts with 3D navigation (p < 0.0001). CONCLUSION: This preclinical study has demonstrated the significant benefit of navigation-guided osteotomies for sinonasal tumors. Translation into the clinical setting - with rigorous assessment of oncological outcomes - would be the proposed next step.
Authors: Stefano Taboni; Marco Ferrari; Michael J Daly; Harley H L Chan; Donovan Eu; Tommaso Gualtieri; Ashok R Jethwa; Axel Sahovaler; Andrew Sewell; Wael Hasan; Ilyes Berania; Jimmy Qiu; John de Almeida; Piero Nicolai; Ralph W Gilbert; Jonathan C Irish Journal: Front Oncol Date: 2021-11-11 Impact factor: 6.244
Authors: Axel Sahovaler; Harley H L Chan; Tommaso Gualtieri; Michael Daly; Marco Ferrari; Claire Vannelli; Donovan Eu; Mirko Manojlovic-Kolarski; Susannah Orzell; Stefano Taboni; John R de Almeida; David P Goldstein; Alberto Deganello; Piero Nicolai; Ralph W Gilbert; Jonathan C Irish Journal: Front Oncol Date: 2021-11-01 Impact factor: 6.244
Authors: Mónica García-Sevilla; Rafael Moreta-Martinez; David García-Mato; Gema Arenas de Frutos; Santiago Ochandiano; Carlos Navarro-Cuéllar; Guillermo Sanjuán de Moreta; Javier Pascau Journal: Front Oncol Date: 2022-01-04 Impact factor: 6.244