Aug 24, 2016 | By Alec

As regular readers will have doubtlessly noticed, 3D printing has become a full-fledged hospital technology. 3D printers have especially become popular among surgeons for the planning of particularly unusual surgeries, in which bones have been completely shattered or implants need to be installed. But over the past few months it has become apparent that cancer patients can also benefit from 3D printing. Back in June, we saw how one Australian man received a whole new 3D printed jaw after a long battle with cancer. And now Indian surgeons from Bangalore have shown that 3D printing can also be used to prepare for surgeries on a type of cancer that is becoming increasingly common: tongue cancer.

For a team of surgeons from the HealthCare Global Cancer Centre in Bangalore, India, has just become the first in the world to use 3D printed models to prepare for tongue cancer surgery. The patient in question is a 53 year old local man from Indore, who travelled to the hospital to deal with a frequently recurring mouth ulcer. The doctors, who refer to the patient as Mr. Ravi (not his real name), were concerned because the patient had already been treated for tongue malignancy two years ago. An MRI scan subsequently revealed that the tumor had spread much further than the small ulcer that was initially spotted. This presented a challenge for the Head & Neck Surgical Oncology team headed by Dr. Vishal Rao, who were faced with the prospect of removing a very large portion of the tongue.

But as Dr. Rao explained, this is not just a one-off situation. In fact, the prevalence of these kinds of cancers in India is rising dramatically. “We are the oral cancer capital of the world; mouth or tongue cancers are fairly common in our country due to habits like chewing tobacco. While it's our duty to look at preventive measures, we need to constantly innovate and help improve treatment paradigms and the quality of life. We must create a benchmark for the world to follow rather than wait for the West to solve our problems,” he argued. In fact, 4 out of 10 cancer occurrences in India are of the oral kind, and doctors are in desperate need of a low-cost solution to combat this epidemic.

As it turns out, 3D printing might be that solution, as it can provide surgeons with information that will help them to precisely remove cancerous portions of the tongue and throat – instead of just cutting out the complete tongue and hoping that this solves it. Dr. Rao and his team therefore turned to local 3D printing specialists Anatomiz 3D LLP. “They made a 3D print out of the tongue and tumor, featuring a simple color demarcation to help the team plan the surgery. The team headed, by Dr Prashanth Puranik, then used that 3D printed model to recreate an exact replica of the tongue from thigh muscle tissue,” Dr. Roa explained.

To actually build that model, Anatomiz3D LLP utilized Materialise’s Mimics software, which has FDA and CE approval. This, as they explain, allows them to edit the DICOM data of CT and MRI scans. The resultant 3D model can be 3D printed in various materials and colors. In this case, an MRI scan was used and the model was segmented into two different parts: one healthy, one cancerous. This was 3D printed in separate colors, at a 1:1 scale. The final model, they say, was perfect for helping the surgeons understand the depth, position and size of the tumor.

The advantage of this approach is clearly visible in the photos above (blue representing cancer, brown the normal tissue), as the ulcer is just the tip of the cancer iceberg. Thanks to 3D printing, the surgeons could properly visualize the situation and plan the tumor’s extraction. For the oncology surgeon, it was a huge improvement over the usual palpation technique with 2D images, which don’t fully show the extent to which the cancer cells have spread.

But the plastic surgery team, headed by Dr. Puranik, were also very happy with the model. It provided them with exactly the right amount data necessary for their tissue implant, and ensured a satisfactory cosmetic and functional outcome. This in turn also benefits the patient, who retains most of his swallowing and speech functions. But 3D printed models also make it far easier to educate patients about the coming surgical procedure, as doctors have found that MRI scans are not always understood. This also means that patients can be better prepared to accept the outcome and rehabilitation plans.

The surgery on Mr. Ravi was a complete success, and he is currently living completely cancer free. To the best of our knowledge (and that of the Indian surgical team), this is also the first time that multiple flexible materials have been 3D printed to mimic tongue tissue for cancer surgery. And if the cancer figures for India are anything to go by, it will definitely not be the last time that this procedure is used.

 

 

Posted in 3D Printing Application

 

 

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