DESCRIPTION (provided by applicant): Malignancies of the brain are among the most devastating diseases known. Glioblastoma multiform (GBM) in particular are known for their rapid, uncontrolled, and aggressive growth. Very little progress has been made in the treatment of GBM over the past 25 years. A more recent promising therapeutic approach is convection enhanced delivery (CED) in which chemotherapeutics are infused under positive pressure and in high volumes directly into the tumor and surrounding tissue. However, the present methods for CED are suboptimal. Large- bore infusion cannulas are used which limit accuracy in placement and result in unacceptable backflow, or "reflux", back up along the cannula walls and away from the target. The present application proposes the re- engineering and testing of a CED system (CEDSYS) that addresses these pitfalls. The resulting delivery system may enable effective medicines to be delivered more efficiently, reducing morbidity and mortality in patients with brain cancer. Further, the system and method may have applications to other diseases requiring broad distribution of therapeutic, such as stroke or some neurodegenerative diseases. The overall goal of this phase of the project will be to develop and refine the CEDSYS, ultimately translating it into a well-engineered instrument suitable for human clinical use. The salient innovation of the CEDSYS is as a single device that will marry the capability of precise placement of large volumes of therapeutic via multiple microtubes within discreet brain regions, while incurring minimal reflux of infusate back along the microtubes insertion track. In Phase I proof of concept will be established. Specific project tasks will include: 1.) Design and fabrication of a microtube placement tool, 2.) Adaptation of the FHC microTargetingTM Platform as a means of stereotactic placement and fixation of multiple microtubes, 3.) Assessment of current infusion apparatus and parameters, 4.) Testing of the prototype CEDSYS in an in vitro model of brain tissue, and 5.) Optimization of design specifications based on test results. The feasibility of this approach will be established if both placement and fixation of multiple microtubes can be demonstrated to be accurate and stable and if infusion can be performed without reflux of infusate.
PUBLIC HEALTH RELEVANCE: A diagnosis of malignant brain cancer is essentially a death sentence. The survival time is typically less than a year from the time of diagnosis. It is estimated that in 2009, 22,070 malignant brain tumors will have been diagnosed. The proposed CEDSYS offers a credible option for patients with aggressive malignancies - for which no effective treatment exists.