Operations Research Advances Cancer Therapeutics

Memorial Sloan-Kettering Cancer Center (MSKCC), the world’s oldest private cancer center, seeks nextgeneration cancer treatment advances to enhance its ability to treat patients effectively by improving care and reducing costs. Using operations research approaches, our team has devised sophisticated optimization modeling and computational techniques for real-time (intraoperative) treatment of prostate cancer using brachytherapy (the placement of radioactive “seeds” inside a tumor). The resulting system offers significantly safer and more reliable treatment outcomes. In addition, it eliminates the need for preoperative simulation and postimplant dosimetric analysis, resulting in savings of hundreds of millions of dollars per year in the United States alone. Posttreatment quality of life is improved through drastic reduction (up to 45–60 percent) of complications. The reason for this is twofold: (a) treatment plans thus devised deliver less radiation to adjacent healthy structures, and (b) the ability to perform midimplant replanning eliminates the unavoidable discrepancies between planned and actual seed placement in the target. This has a profound impact on the cost of managing treatmentassociated morbidity. The procedure uses approximately 20–30 percent fewer seeds and 15 percent fewer needles (used to place seeds inside the prostate gland). As a result, the operating-room time is shortened, and the entire procedure is less invasive. The system has the potential to establish standards and guidelines for cancer treatment quality control and quality assurance of the implantable plan. Wide distribution of our system should allow consistent treatment planning across different clinics and significantly reduce variability in treatment plan quality. The next phase of this effort will expand the applicability of our system to other forms of brachytherapy, such as treatment of breast, cervix, esophagus, biliary tract, pancreas, head and neck, and eye.