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MINISTÈRE DES AFFAIRES ÉTRANGÈRES ET EUROPEENNES
No. 39 – October 2008
A world first for neurosurgery in France
A French team at the Pitié-Salpêtrière hospital in Paris,
led by Professor Alexandre Carpentier, has just revealed that it
has managed for the first time to destroy metastasic tumours in
the brain without opening up the skull, using laser. This
development offers fresh hope to cancer patients and paves the
way for a new application for nuclear magnetic resonance
imaging.
It all sounds quite simple: a small hole is pierced in the skull
and a fibre-optic cable ending in a laser is passed through the hole
until a cerebral metastasis is reached. The laser is turned on and the
tumour is destroyed in under two minutes. The whole process is
controlled in real time using nuclear magnetic resonance imaging
(MRI).
Professor Alexandre Carpentier
First, a team of neurosurgeons uses MRI to identify the precise location of the tumour to be
destroyed. A three-millimetre diameter opening is then made in the skull to introduce the fibre optic
cable, which is fitted with a laser. A computer-based simulation is used to check that the laser is
correctly positioned in the centre of the tumour, and then the laser is turned on, heating the tumorous
tissue and destroying it.
Highly sophisticated technology lies behind this apparently simple process, developed by the
French in conjunction with American researchers at the MD Anderson Cancer Centre in Houston and
the company BioTex at the University of Texas Medical Branch (UTMB). Professor Carpentier
emphasises that "this is the first time laser technology has been used in an intracranial environment
and combined with MRI to provide data in real time. This is a new stage in the use of MRI in
neurosurgery, as part of a surgical operation."
MRI plays a decisive role throughout the operation, with the sequences of images, provided in
real time, being used to control the thermal treatment. These data provide a precise indication of the
temperature of diseased tissues. The computer system controls the amount of energy delivered by the
laser based on these parameters.
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The laser used can be "chilled" on a continuous basis, which makes it possible to avoid
coagulates forming on its contact. Destroying metastasic tissue directly by necrosis has neither led to
intracerebral oedema nor has it caused epileptic fits in the patients treated. In addition to the simplicity
and safety of the treatment, the procedure significantly improves the conditions under which the
operation takes place: the patient lies in the MRI scanner and is conscious but does not feel anything.
The surgery is carried out under a local anaesthetic and the patient can leave the hospital the same
evening.
These operations are the final phase of a clinical trial involving fifteen people. The life
expectancy of patients treated in this way has been significantly extended. The trial, which was
supervised by the French agency for the safety of healthcare products (Afssaps), involved patients
suffering from cerebral metastases that appeared following various types of cancer, in particular of the
breast and lung (it is estimated that around 20% of patients who die from cancer have one or more
cerebral metastases). "As a result, the life expectancy of these people was no more than three months
or so," points out Professor Carpentier.
The fifteen patients were treated between December 2006 and February 2008 in order to assess
the safety and effectiveness of the procedure. After analysing the results achieved on the first six
patients, a committee of independent experts issued an authorisation for the trial to continue,
broadening its indications, in March 2007. The team was therefore able to treat patients suffering from
several intracerebral metastases as well as larger metastases of up to three centimetres in size.
In all, nine of the fifteen treatments carried out were partial and the remaining six full. Of the
latter group, five of the six patients showed no signs of a recurrence for an average of nine months.
The team therefore feels it has now achieved some very satisfactory results. Professor Carpentier, who
runs the advanced surgical technology research laboratory at Pitié-Salpêtrière, is developing an
ambitious research programme with a physicist, Julian Itzcovitz, looking in particular at how "to use
focused ultrasound as a complementary therapy, still under MRI control, to destroy intracerebral
tumours." The eternal problem remains, however: in spite of the 50,000 euros brought in by the 2008
prize for technological innovation that Professor Carpentier has just received, he still lacks the funding
he needs. Perhaps the great interest aroused in the profession and the media will help to change the
situation!
Sylvie Thomas
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