Both NCT sites work towards the individualization of surgical treatments in terms of precision oncology. One joint key mission is the establishment of the field of surgical data science, aimed at improving the quality of interventional healthcare and its value through the capture, organization, analysis and modeling of all available data from the treatment process chain.
Joint Aims, Strategy and Perspectives
A strategic priority is therefore to develop the future infrastructure, tools and workflow concepts for enabling data-driven surgical oncology and multidisciplinary data science. Both NCT sites play a leading role in the International Surgical Data Science initiative (www.surgical-data-science.org), launched to further increase the visibility of the NCT sites as leading institutes in the field of surgical data science.
Further activities in the field of computer- and robotic-assisted systems complement each other ideally at both NCT sites, aimed at enabling the successful translation of research results via strong clinical collaborations. The NCT sites in Dresden and Heidelberg join efforts in a Dresden-led DKTK initiative with the goal of identifying predictive biomarkers for individualized surgical treatment of colorectal and pancreatic cancer. The consortium combines unique surgical expertise and access to a broad patient cohort to build up a comprehensive and valuable database which is amenable to broad scientific use. Excellent clinical infrastructures and a high annual caseload allow the NCT sites to jointly run several elaborate clinical trials (e.g. SYNCHRONOUS). Future trends lie in the clinical validation of treatment stratification, using functional characterization in preclinical models (e.g. OPPOSITE).
Research Profile NCT Heidelberg
The mission of the NCT Heidelberg regarding the area of surgical oncology is to establish the field of surgical data science in the complex research and clinical environment of the NCT. An additional aim is to develop a lighthouse clinical studies program that allows researchers from the University Hospital and the DKFZ to conduct clinical studies in the field of surgical oncology with potential practice-changing impact. The current research focuses on three areas: (1) data science driven surgical oncology: enabling personalized treatment based on data-driven approaches. (2) Advanced imaging: developing novel surgical imaging concepts based on biophotonics techniques. (3) Tumor microenvironment: targeting the metastatic microenvironment to augment prognosis prediction and treatment.
Surgical data science and translational research activities are complemented with a highly active center of clinical trials situated within the Department of Surgery. Within this framework, surgical oncology patients are recruited into 18 currently active clinical trials, focusing on various aspects of surgical technique and resection strategies in gastrointestinal cancer.
Surgical Oncology NCT Heidelberg - Selected Activities
Data Science Driven Surgical Oncology
Data Science Driven Surgical Oncology (DSDSO) aims to improve the quality and value of surgical oncology through capture, organization, analysis and modeling of data. It will provide the surgeon with quantitative support to aid decision-making and surgical actions and importantly, it will link decisions to patient outcomes. A strategic priority of DSDSO is to develop future infrastructure, tools and workflow concepts for DSDSO with the long-term vision to translate novel data science algorithms into clinical routine. A methodological focus is put on generalizable, uncertainty-aware and explainable AI.
Maier-Hein et al., Nat Biomed Eng 2017; Ardizzone et al., ICLR Conference Paper 2019
Key challenges in tumor diagnosis and therapy lie in the detection and discrimination of malignant tissue as well as the precise navigation of medical instruments. Currently, a low level of sensitivity and specificity in tumor detection and lack of global orientation lead to both over- and under-treatment, tumor recurrence, intraoperative complications and high costs. The goal of this multidisciplinary project is to revolutionize clinical imaging based on the systematic integration of two new but as of yet independent fields of research - biophotonics and computer-assisted interventions. Current highlights are related to tissue classification and perfusion monitoring using multispectral optical and photoacoustic imaging. Entities explored so far are kidney, esophagus, colon and brain.
Kirchner et al., J Biomed Optics 2018; Moccia et al., Trans Biomed Eng 2018
Tumors are influenced by the composition and mechanical properties of the tumor microenvironment. In order to decipher prognostically and therapeutically relevant features that are intrinsic to the tumor microenvironment in metastatic colorectal cancer, state-of-the-art methods are applied on a broad collection of surgical resection specimens. For instance, VEGFR1-positive-circulating cells were identified as promising biomarkers of disease recurrence and it was demonstrated that survival of patients undergoing multimodal treatment of colorectal liver metastases is significantly affected by hepatic expression of metabolic enzymes. Recent work reveals that drugs targeting the renin-angiotensin system reduce metastases-associated fibroblast activity, thus decreasing tumor stiffness. In combination with anti-angiogenic therapy, this leads to improved blood vessel integrity and longer life expectancy. Collectively, findings from this activity could lead to novel prognostic tools and treatment algorithms for metastatic colorectal cancer.
Freire et al., Clin Cancer Res 2019; Strowitzki et al., Br J Cancer 2019