7 new protocols have been affiliated to ACROBATIC since its beginning in January 2022

6 new protocols have been affiliated to ACROBATIC in 2023

Since ACROBATICs beginning in January 2022, 7 new protocols belonging to CFA2 and CFA3, have been affiliated. This means that ACROBATIC now has 41 protocols affiliated. You can read more about the affiliated protocols below:

WP 2.17 – WP leader Thomas Baad-Hansen (Aarhus University Hospital): Applying robot-guided laser osteotomies in malignant bone tumor resection and introducing interlocking osteotomies.

Abstract: Bone sarcomas are rare neoplasms and represent less than 1% of all cancers. Regrettably, sarcomas are resistant to both chemo- and radiation therapy. Therefore, the cornerstone in sarcoma management is surgery. Basically, the surgical treatment consists of two parts, tumor removal and reconstruction of the affected region. Often biological reconstructions utilize the patient’s own bone stock (structural autographs). Traditionally the bone is cut with saws and while mechanical tools only cut straight or slightly curved lines, robot-guided laser osteotome can create custom geometries. As a result, bone segments can slot together like puzzle pieces, making the use of metal plate and screws systems superfluous. Also, the larger contact surface can facilitate the healing process. A shift from conventional surgery to computer-assisted patient-specific interventions will allow a faster recovery, enabling MRI follow up due to the lack of metal implants allowing detection of local recurrence. An important tool in personalized surgery is the use of operating robots. While robot surgery is still in its infancy in orthopedic oncology, it is widely implemented in, e.g., general surgery. The key question to be answered by this project is how we can adapt and develop new treatment options based on robotic surgery for the benefit of this group of patients. The project has the potential to reduce time-to-treatment, re-surgery, increased quality of life, and improve overall survival.

WP 2.18 – Trine Tramm and Jasper Nijkamp (Aarhus University Hospital): Towards preventing reoperations in breast cancer patients with intraoperative surgical margin assessment using spectral microCT.

Abstract: In Denmark, annually over 550 (18%) breast cancer patients need a re-operation after initial breast conserving surgery (BCS), due to incomplete removal of the cancer or ductal carcinoma in situ (DCIS, pre-stage of cancer). The need for reoperation is determined days after surgery based on microscopic identification of cancer/DCIS at the edge of the surgically removed tissue (= surgical margin). Ideally, the tissue should be evaluated in the operating room, allowing for immediate additional tissue removal, preventing re-operations. Several intraoperative technologies have been developed for this purpose but with disappointing results, especially in finding DCIS, which is the leading cause for re-operations. We have developed a novel imaging technique, a spectral photon counting micro computed tomography (CT) scanner, potentially overcoming the deficiencies of existing intraoperative technologies. In this translational study, we aim to evaluate the performance of spectral microCT scanning for margin assessment in a clinical setting at the pathology department. In the first part of the project, routine BCS specimen will be scanned and spectral CT data is correlated with histology. This will define the relation between the novel imaging data (specifically the spectral information) and the gold standard (histology). In the second part, the acquired data will be used to develop artificial intelligence tools to support fast, reliable assessment of surgical margins. In the last part of the project, the performance of the margin assessment tool will be tested prospectively in a consecutive patient cohort without clinical intervention. This study will provide clinically relevant insight into the potential of spectral microCT imaging for fast, intraoperative surgical margin assessment in BCS; a tool that may be extended to other cancer types. It will be the foundation of future prospective, randomized clinical trials aiming to significantly reduce the need for re-operations.

WP 2.19 – WP leader Tove Tvedskov (Copenhagen University Hospital): Oncologic events after subcutaneous mastectomy with or without conservation of the nipple-areola complex.

WP 3.12 – WP leader Thomas Decker Christensen (Aarhus University Hospital): Venous thromboembolism in patients with primary lung cancer: Integrating information strategies to promote patient empowerment.

Abstract: Timely identification and treatment of venous thromboembolism (VTE), particularly pulmonary embolism, in lung cancer patients is challenging and crucial for prevention, early detection, treatment, and prognosis. VTE in lung cancer patients results increases morbidity and premature death. There is no reliable risk assessment tool for predicting VTE risk in lung cancer. The overlapping symptoms of VTE and lung cancer complicate timely diagnosis and treatment. Health care professionals’ (HCP) communication regarding VTE is generally inadequate. This project aims to explore the experience of VTE symptoms in the context of lung cancer. Specifically, we will explore and characterize the experience and perception of symptoms and signs of VTE in relation to lung cancer symptoms. In a co-creation process involving workshops with patients and HCPs, we will develop, implement, and evaluate the effectiveness of an information video integrated into a digital care guide. The video will account for the symptomatic profile of pulmonary embolism in lung cancer. We will collaborate with patients and HCPs to identify relevant endpoints for measuring the video’s effectiveness covering aspects such as awareness, symptom, morbidity, mortality, health care resource utilization, quality of life, and satisfaction. The video will be implemented in clinical practice in an existing digital care guide. With a pre-post design, the study will compare outcomes in lung cancer patients with VTE before and after implementation. Ultimately, this project aims to facilitate effective, personalized treatment decisions to reduce adverse events and healthcare costs, with potential for national implementation and adaption to other cancer populations.

WP 3.13 – WP leader Mads Hvis Aaberg Poulsen (Odense University Hospital): Early Rehabilitation with a Vacuum Erectile Device in Patients Undergoing Nerve-sparing Robotic‑assisted Radical Prostatectomy A Randomized Trial.

Abstract: The aim of this trial is to study the efficacy of a vacuum erectile device (VED) in rehabilitating the erectile function, penile length, early continence, and quality of life of patients undergoing nerve‑sparing robotic‑assisted radical prostatectomy. This prospective randomized trial will enroll 120 prostate cancer patients gathered from three sites in Denmark. The patients must have an intact baseline erectile function, be continent and wellbeing prior to the nerve‑sparing robotic‑assisted radical prostatectomy. The patients will be randomly assigned (1:1) into either an experimental group which applied the VED for 10 min daily for 6 months or a control group which received no additional interventions prior to surgery. The VED will be initiated one month prior to the surgery. The measurements are the 5‑item version of the International Index of Erectile Function (IIEF‑5) score, stretched penile length, mid-shaft circumference, and EPIC-26, EQ5D-5L at baseline, 1, 3, 6 and 12 months after surgery, respectively. The primary endpoint will be IIEF-5 after 12 months. The trial is planned to initiate in winter 2023. The trial is made in collaboration with the Danish Prostate Cancer Group, DaProCa, and with support of two patients.

WP 3.14 – WP leader Claus Lindbjerg Andersen (MOMA): Implementing non-invasive circulating tumor DNA and circular DNA analysis in patients with localized pancreatic cancer to optimize the pre- and postoperative treatment: predicting recurrence and survival and changing prognosis over time.

Abstract: Patients diagnosed with pancreatic cancer (PC) have a dismal prognosis with a 5-year overall survival (OS) of only 10%. Less than 20% of patients with PC are eligible for curative resection, and around 80% of resected patients experience relapse within the first few years after surgery. Circulating tumor DNA (ctDNA) and extrachromosomal circular DNA (eccDNA) in blood are emerging new tools for monitoring disease progression and recurrence. To explore the utility of ctDNA/eccDNA in PC, we have initiated CIRCPAC, a national multidisciplinary translational study. We will include 700 patients with suspected PC and explore whether ctDNA/eccDNA are prognostic markers for OS. Of those, 410 will additionally be included in a randomized controlled trial, where the intervention is a new intensive follow-up program, with longitudinal ctDNA measurement, endoscopic ultrasound, and CT imaging. The endpoints, in terms of time to recurrence, OS, quality of life, and health economic costs, will be compared to standard-of-care after three years follow-up. The study includes all four Danish PC centers. Inclusion started in January 2023 and will expectedly run for three years. We foresee that ctDNA/eccDNA biomarkers will reveal much needed diagnostic and predictive discriminatory abilities, that can be used to identify high-risk patients suspected of PC in the daily clinical practice. Further we hope that an intensive follow-up strategy will improve recurrence treatment, and thereby OS, as well as quality of life for patients with PC.

WP 3.15 – WP leader Tine Engberg Damsgaard (Vejle Sygehus): Empowering breast cancer patients to assess and address their breast cosmetic outcome afterbreast conserving therapy

Abstract: Follow-up (FU) of breast cancer patients is evolving from hospital consultations, towards screening programs for recurrence detection, and patient reported outcomes (PROMs) for quality of-life and morbidity. In this project we focus on the breast cosmetic outcome (CO), which is assessed as fair or poor by 20% of patients in clinical trials. Patients with a fair/poor CO have a lower body image score, find themselves less sexually attractive, and score lower on overall quality-of-life compared to patients with an excellent/good score. For 90% of patients treated outside of clinical trials, there is currently no systematic assessment of CO. With the intended national roll-out of PROMs, we can expect that 20% of patients will report a fair or poor cosmetic outcome at some time during their follow-up. Our healthcare system is currently not equipped to address these patients. This is further complicated by the fact that CO scoring by physicians only poorly correlates with patient assessments. The goal of this project is to develop an objective self assessment photo tool that can be used alongside the PROMs. By combining objective and subjective CO scoring, we aim to develop a selection scheme that ensures which patients need to be seen by which healthcare professional.