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Advancing tools and techniques for virtual surgical planning and the personalized treatment of patients with oral cancers

Approximately 5,000 Canadians are diagnosed with oral cancer each year. Many of these patients undergo aggressive surgeries to remove their tumours, which can result in significant impacts on their quality of life through the removal of sections of the jaw and surrounding soft tissue.

Addressing these impacts requires an advanced surgery known as jawbone (or mandibular) reconstruction.

To conduct mandibular reconstruction, surgeons need to transplant a section of bone from the hip, leg or shoulder and are often required to make on-the-spot decisions about bone placement, size and orientation. Unfortunately, this surgery is still largely unsuccessful, and can lead to lifelong difficulties performing essential tasks such as speaking, chewing and swallowing.

With $2.4 million over five years from a Terry Fox New Frontiers Program Project Grant (PPG), a multidisciplinary team of surgeons, engineers and radiologists aim to significantly improve outcomes and quality of life for patients undergoing surgery for oral cancer. They will do this through the development, testing and implementation of tools and techniques that will enable surgeons to better prepare for surgery and personalize treatment for each patient.

The first step in this process is to optimize virtual surgical planning (VSP) software, a technique that allows surgeons to plan the reconstructive surgery in advance, creating 3D-printed cutting guides that can be used in the operating room. In addition to improving surgical outcomes, the use of VSP also improves surgical efficiency, allowing surgeons to complete more surgeries per day.

“While VSP has great promise in improving care, there are still various limitations and opportunities to improve the utility of VSP and its application to various other components of the cancer care workflow. Currently, VSP solutions are cost prohibitive and as such are not applied routinely in the Canadian Health Care system,” says Dr. Eitan Prisman, clinical associate professor at the University of British Columbia. “Our goal is to provide high-quality evidence for the benefits of an accessible, low-cost VSP solution.”

To do so, Dr. Prisman and team have developed a cheaper, in-house VSP solution using open-sourced software. As part of their PPG, they will perform a randomized controlled clinical trial at nine sites across Canada, introducing the technology to these facilities and comparing its effectiveness with traditional free-hand surgery.

They will then work to improve the accuracy of VSP by incorporating functional models that account for the forces of chewing and create a new day-of-surgery system (DOSS) to increase optimization. Using image guidance and a built-in algorithm, the DOSS will calculate precise data on the spot, accounting for any tumour growth that may have occurred between the date the VSP guides were created and the day of surgery. “The results of this calculation will then guide the surgeon’s instruments to harvest the appropriate transplant and place this into the jaw for the reconstruction,” says Dr. Prisman.

This will be developed and tested in a pilot study and then applied clinically. Lastly, they will create a virtual interactive platform (VIP) to improve communication and collaboration between various health professionals treating patients with oral cancers.

“With the generous support from TFRI, we will be able to further optimize care and quality of life for patients with oral cancer and oral diseases across Canada,” says Dr. Prisman.

Funding for this new New Frontiers Program Project Grant in Advanced Virtual Surgical Planning and Intraoperative Tools for Enhancing Patient‐Specific Surgical Care for Oral Cancers is provided equally by the Terry Fox Foundation and the Lotte & John Hecht Memorial Foundation.