A 2020 report from The International Agency for Research on Cancer (IARC) estimated that as many as 1 in 5 people globally would experience a form of cancer during their lifetime.
Global aging populations and a range of socio-economic risk factors represent some of the key drivers of this increase. There is an ever-increasing demand for cost-effective, accessible, efficient, and patient-centered cancer therapy and treatment.
Ariane’s Papillon+™ system offers medical practitioners a turnkey solution to successful rectal, superficial and intraoperative X-ray brachytherapy via a range of treatment modalities.
Principles of X-ray Brachytherapy
X-ray brachytherapy is a method of short-range radiation therapy for the localized treatment of tumors; particularly in the skin, uterus, breast and rectum.
This technique offers the potential for reduced treatment time versus more conventional radiation treatments; using a nominally invasive procedure to insert an X-ray tube at the target location before applying low energy x-ray beams to destroy cancer cells selectively.
Duration, dose and the number of x-ray brachytherapy sessions are dictated by tumor stage and severity, allowing this treatment to be tailored to a patient’s specific needs as part of a personalized care package.
Centering Patient Choice and Care
The Papillon+™ X-ray brachytherapy system from Ariane has been designed and developed with patient choice, welfare and successful treatment at its core.
This increasingly accepted, validated and popular system offers an effective means of treating accessible cancers. The Papillon+™ system provides a viable, less invasive alternative to high dose rate radioisotopes for rectal, IORT (including breast) and skin-focussed procedures. Work is ongoing on expanding these capabilities to include intra-vaginal and laparoscopic X-ray brachytherapy.
The mobile housing, extended reach and minimal footprint make the Papillon+™ highly suited for deployment in a wide range of settings, particularly the operating room. The system is highly positionable, allowing easy access to localized cancers while ensuring optimal patient comfort.
Adaptability is further enhanced as Papillon+™ is controlled remotely via a bench- or trolley-mounted workstation featuring a user-friendly touch screen display and PC base unit. This setup facilitates interchangeable treatment room or remote operation and minimizes cabling requirements and helps ensure patient and staff safety.
The Papillon+™ instrument is powered by a Micronode© monoblock-type assembly featuring a high voltage generator and x-ray tube. The system can generate 150 watts of power, extracted via forced liquid cooling – this allows for the delivery of up to 20 Gys per minute via a 310° homogeneous beam, depending on specific treatment requirements and application setting.
The system also features a range of optional features, including the Monitus™ on-board controlled area warning system (able to trigger a series of radiation-on alert lights) and the Prefectus™ compatible quality assurance system (able to quickly and easily verify dose and beam energy against pre-determined reference measurements).
Papillon+™ in Practice
The X-ray tube integrated into the Papillon+™ instrument features an interchangeable treatment adaptor, allowing it to be utilized in a range of treatments and settings.
While surgery remains the gold standard for rectal cancer treatment, the increasing prevalence of personalized care approaches and the importance of patient choice have prompted the need for alternative methods.
Papillon+™ can be used to treat rectal tumors where these are T1 – T3 with little or no nodal involvement. These cases have historically required radical surgery, frequently involving the removal of the anus and leaving the patient with a lifelong stoma.
Depending on the tumor’s size, staging and positioning, it may be possible to employ the Papillon treatment in isolation or in conjunction with chemotherapy, external beam radiotherapy or local surgical techniques.
The use of this approach – and the increase in national screening programs and early detection – offers a potentially much less harmful, more cost-effective option for the treatment of rectal tumors.
Papillon+™ can be used for intraoperative radiotherapy – the application of internal radiotherapy treatment to a surgically exposed tumor site while a patient is under general anesthesia. Low energy x-rays can be applied to an exposed cavity following the removal of a tumor in breast-conserving lumpectomy surgery.
This process adds an average of 120 seconds to an existing procedure while delivering up to 20 Gy of treatment, minimizing the time that patients must be kept under anesthetic while providing an effective means of ensuring successful treatment. The specific applicator for this application is lightweight and autoclavable.
The globally aging population has seen an increasing prevalence of non-melanoma skin cancers (NMSC), particularly Squamous Cell Carcinomas (SCC) and Basal Cell Carcinomas (BCC) from sun exposure. These tumors are clinically non-invasive and frequently grow slowly, while representing >75% of all skin cancers.
These cancers are frequently located on exposed sites including the hands, face, ears, and neck; prompting specific cosmetic issues and aesthetic considerations where there is a need to minimize scarring and side effects through non-invasive therapies.
X-ray brachytherapy has been shown to provide good local control and excellent cosmetic results when treating T1 and T2 tumors. The range of applicators available for the Papillon+™ makes this an ideal instrument for treating skin cancers, particularly given the diverse and sensitive nature of their locations.
Summarizing the Business Case
As well as providing excellent benefits to patients, the cost-effective, affordable Papillon+™ X-ray brachytherapy system from Ariane provides an array of benefits to radiotherapy or brachytherapy departments.
Any reduction in the need for surgery will result in decreased costs – both in terms of the surgical procedure itself and the need for ongoing care. This is particularly important when considering the long-term care implications of stomas. The potential for rapid treatment with fewer complications is also a key driver in increasing patient throughput, while maintaining optimum patient care.
The Monitus™ warning light triggering system and Prefectus™ on-board quality assurance features help facilitate safe room use without the need for extensive capital expenditure on treatment or operating room modifications.
These robust features are combined with the system’s low-level shielding requirements, offering a truly mobile, flexible solution for localized cancer treatments.