Planificación quirúrgica mediante impresión 3D

3 07 2014

El Hospital Sant Joan de Déu utiliza una impresión en 3D de un tumor para planificar una intervención extremadamente compleja a un niño de 5 años

 

Un equipo de cirujanos del Hospital Sant Joan de Déu ha planificado detalladamente una intervención de gran complejidad dirigida a extirpar un tumor gracias a su reproducción mediante las tecnologías de impresión 3D de la Fundació CIM, centro tecnológico punto de la Universitat Politècnica de Catalunya – Barcelona Tech (UPC).

 

El tumor reproducido es un neuroblastoma, uno de los cánceres más frecuentes en la población infantil y que supone el 10% de los cánceres diagnosticados a niños. Se trata de un tumor extremadamente agresivo que se forma en el tejido nervioso y que se diagnostica principalmente a los niños durante los primeros cinco años de vida. Su tratamiento implica la extirpación quirúgica del tumor, combinado de quimioterapia y/o radioterapia.

 

Su extirpación quirúrgica, sin embargo, plantea muchas dificultades porque, debido a su localización, el neuroblastoma rodea vasos sanguíneos, arterias y los cirujanos tienen que proceder con una extremada precisión para extraer las células tumorales sin dañar las arterias y poner en peligro la vida del paciente. En este contexto, la posibilidad de poder ensayar la intervención con antelación es clave. Permite a los cirujanos estudiar cual es la manera más efectiva de abordar el tumor ensayandola reiteradamente antes de la intervención. Además, permite reducir el tiempo de la operación, evitar complicaciones y estudiar la vía para extirpar el mayor porcentaje de tumoración posible.

 

Para poder planificar las extirpaciones de los tumores más complejas, que a veces resultan inoperables, un equipo de cirujanos del Hospital Sant Joan de Déu ha optado por comenzar a hacer reproducciones en 3D. En colaboración con la Fundación CIM de la Universitat Politècnica de Catalunya – BarcelonaTech (UPC), han realizado un copia en 3D del neuroblastoma que presentaba un niño de 5 años. Para hacerla, los técnicos de la Fundación CIM han cruzado los datos de una tomografía computerizada y una resonancia magnética realizadas al niño.

 

A pesar que ya hace años que se utilizan impresiones en 3D en el campo de la cirugía maxilofacial, para la reproducción de huesos, la aplicación para tejidos blandos es un novedad. La dificultad que plantea su uso en el caso presentado es doble:

 

  • Es necesario un trabajo conjunto entre técnicos radiólogos y de fabricación para revisar las digitalizaciones de la zona afectada y decidir cuales son los contornos reales de los tejidos.
  • La impresión se ha tenido que hacer con dos materiales diferentes y lo más parecido posible a los tejidos blandos sobre los que los cirujanos han de intervenir.

 

La copia del tumor ha sido hecha mediante una tecnología que permite la impresión en dos tipos de materiales. Se ha utilizado una resina para reproducir los vasos sanguíneos y órganos de la zona afecta, y otra translúcida y de consistencia blanda parecida a la de la tumoración para que los cirujanos puedan probar de extraer sin dañar los vasos y órganos. Complementariamente, también se ha fabricado un prototipo con los órganos sin el tumo, para poder visualizar el resultado ambicionado al hacer la intervención.

 

 

Hsjdbcn.org [en línea] Barcelona (ESP): hsjdbcn.org, 03 de julio de 2014 [ref. 02 de julio de 2014] Disponible en Internet: http://www.hsjdbcn.org/portal/es/web/2149152853/ctnt/dD98/_/_/zn0bep/El-Hospital-Sant-Joan-de-Déu-utiliza-una-impresión-en-3D-de-un-tumor-para-planifi.html



European study reveals new causes of mouth and throat cancer

21 04 2014

Poor oral health and failure to have regular dental checks could increase the risk of mouth and throat cancer, according to a pan-European study.

The research also suggests – based on a small number of tumour patients – that excessive use of mouthwash may also cause this particular form of cancer. Excessive use is defined as more than three times a day.

It has been established for some time that smoking and heavy alcohol consumption, particularly in combination, are strongly related to mouth and throat cancers. Low socio-economic status is also recognised as a contributory factor.

Now, however, a new study carried out by researchers at the University of Glasgow Dental School – as part of a Europe-wide collaboration co-ordinated by the International Agency for Research on Cancer and led by the Leibniz Institute for Prevention Research and Epidemiology – BIPS in Bremen, Germany  – has identified new risk factors for upper aerodigestive tract cancer (cancer of the mouth, larynx, pharynx and esophagus).

The study of 1,962 patients with mouth and throat cancers, with a further 1,993 people used as comparison control subjects, was conducted in 13 centres across nine countries and supported by EU funding.

Prof. Wolfgang Ahrens, Deputy Director of the BIPS, said: “These results are really important. Up until now, it was not really known if these dental risk factors were independent of the well known risks for mouth and throat cancers – smoking, alcohol and low socioeconomic status.”

The researchers were able to strip out the causation factors of smoking, alcohol and socio-economic factors, and still found there was a connection between poor oral health and increased risk of mouth and throat cancers.

The findings are highly “nuanced” and there is an interconnectedness of many of the risk factors, he stressed, but there was now evidence that poor oral health and poor dental care were also part of the picture.

The definition of poor oral health included people who had complete or part dentures, people with persistently bleeding gums.

“People should not assume that if they wear dentures and have none of their own teeth left, they have no need to see a dentist,” said Dr David Conway, Clinical Senior Lecturer at the University of Glasgow Dental School and one of the senior authors of the study. “On the contrary, even if you have got dentures, you should make sure you go for regular check-ups,” he said.

People with poor dental care were defined as those who hardly ever or never brushed their teeth or visited the dentist. The frequency of dental visits should be determined by a dentist’s risk assessment and if people fell into the low risk category it could be once a year or even every two years, said Dr Conway.

“It is not a case of ‘one size fits all’. Visits could be six-monthly, but certainly not five-yearly,” Dr. Conway added.

The possible role of mouthwash as a causative factor would require further research, said Professor Ahrens. There might be a relationship between excessive use of mouthwash and people who used it to mask the smell of smoking and alcohol. Nevertheless, the researchers found that “frequent use of mouthwashes (3-plus times per day) was associated with an elevated risk of developing mouth and throat cancer”, although they were unable to analyse the types of mouthwash used many years ago by participants in the study.

Dr Conway said: “I would not advise routine use of mouthwash, full stop. There are occasions and conditions for which a dentist could prescribe a mouthwash – it could be that a patient has a low salivary flow because of a particular condition or medicine they are taking. But for me, all that’s necessary in general is good regular brushing with a fluoride toothpaste and flossing combined with regular check-ups by a dentist.”

The research group, which includes collaborators from Germany, UK, Estonia, Switzerland, Greece, the Czech Republic, Italy, Norway, Spain, USA, Croatia, Ireland and France, have recently received a new tranche of funding from the EU and WHO’s International Agency for Research of Cancer, which will be used to research prognostic factors as well as risk factors.

 

 

Find out more:

 

Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe: the ARCAGE (Alcohol-Related Cancers and Genetic-susceptibility in Europe) study. Wolfgang Ahrens; Hermann Pohlabeln; Ronja Foraita; Mari Nelis; Pagona Lagiou;Areti Lagiou; Christine Bouchardy; Alena Slamova; Miriam Schejbalova; Franco Merletti; Lorenzo Richiardi; Kristina Kjaerheim; Antonio Agudo; Xavier Castellsague; Tatiana Macfarlane; Gary J Macfarlane; Yuan-Chin Amy Lee; Renato Talamini; Luigi Barzan; Cristina Canova; Lorenzo Simonato; Peter Thomson; Patricia McKinney; Alex D McMahon; Ariana Znaor; Claire M Healy; Bernard E McCartan; Andres Metspalu; Manuela Marron; Mia Hashibe; David I Conway; Paul Brennan.

 

Published in Oral Oncology http://www.oraloncology.com/article/PIIS1368837514000657/abstract

 

 

Gla.ac.uk [en línea] Glasgow (UK): gla.ac.uk, 21 de abril de 2014 [ref. 04 de abril de 2014] Disponible en Internet: http://www.gla.ac.uk/news/headline_320819_en.html