Name: endobronchial ultrasound-guided intratumoral injection of cisplatin for the treatment of isolated mediastinal recurrence of lung cancer
Uploaded: 2017-02-12T14:00:00
Description: Watch this Scientific Journal Video about Endobronchial Ultrasound-guided Intratumoral Injection of Cisplatin for the Treatment of Isolated Mediastinal Recurrence of Lung Cancer at JoVE.com

The authors have no acknowledgements.

与EBUS引导顺铂治疗所有患者的数据进行了审查。在佛罗里达大学的机构审查委员会批准了这项研究（＃IRB201400823）。所有数据收集前瞻性和回顾性分析。使用下面的入选标准。 1.病人选择<ol><li>谁拥有活检证实的非小细胞肺癌（NSCLC）或小细胞肺癌（SCLC），并有病理确诊复发的18和80岁之间的患者选择。报名谁收到至少50 GY辐射到肺门和纵隔结构为6个月或更长的患者。包括?...

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<html>我们的手稿集中在肺癌纵隔孤立和肺门复发的管理病人谁更辐射是不是一种选择。 IMHR的发病率约为9％11。不同的治疗方案已经尝试在这些患者中，包括姑息性化疗，更多的外照射放疗，或支持治疗和监测。在我们的机构，我们将这些患者经纤支镜引导下肿瘤内顺铂。 出现了在肿瘤内化疗和免疫过去几年越来越感兴趣。之一的注入化疗剂进入肿瘤块的潜...

肺癌是所有癌症相关死亡的5男女双方，占全球1最常见的癌症。它有0.87 1，2病死率。初次治疗后复发占患者死亡人数最多肺癌。复发性肺癌的治疗选择是有限的。复发性肺癌也导致显著损害生活质量和护理人员显著倦怠并且需要额外的支持治疗，从而会降低接受和容忍的可能性进一步干预3。 NSCLC患者近30％有辐射4后局部复发。对这些患者的治疗选择是有限的，包括全身化疗，其具有仅10％的5，6的客观响应率。虽然重复胸部放疗是可行的，它已被主要研究姑息目的，缓解症状，并没有被用于疾病缓解3。 在我们的机构，孤立纵隔及肺门复发（IMHR）通过支气管镜访问的所有患者均与支气管内超声（EBUS）引导下治疗顺铂支气管内注射（ITC）。全身化疗和/或体外放射治疗（EBRT）并行处理被允许按照所述处理肿瘤学家“酌情。这份手稿突出了安全性，有效性，可行性，并在我们的机构所使用的协议的详细方法。

<table border="0" cellpadding="0" cellspacing="0" width="261">
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			<td colspan="2" height="20" style="height:20px;width:261px;">Bronchoscope</td>
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			<td colspan="2" height="20" style="height:20px;">22 Guage olympus EBUS needle</td>
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			<td colspan="2" height="20" style="height:20px;">40 g of cisplatin in 40 mls of normal saline</td>
		</tr>
	</tbody>
</table>

endobronchial ultrasound-guided intratumoral injection of cisplatin for the treatment of isolated mediastinal recurrence of lung cancer

患者孤立肺门以下体外放射治疗（EBRT）纵隔复发（IMHR）肺癌是常见的。这些患者没有太多的治疗方案，并且通常提供姑息性化疗或最佳支持治疗。支气管内超声（EBUS）引导下顺铂瘤内注射（ITC）是这些患者的新方法。该过程下清醒镇静进行。病变位于使用EBUS支气管镜，和22号针头EBUS通过范围的工作通道先进，锁定到位。在超声引导下，气管支气管树的壁被刺穿并且针移入目标病变。然后将针管心针被移除，顺铂（40毫克/ 40毫升）注射到病灶。一到两个站点每个会话处理。该过程的细节将在纸的协议部分中描述。在我们中心，50个站点中36例患者接受治疗（男性19例，女性17例）。我们的队列的平均年龄为61.9±8.5年。我们对35例患者和41位点进行最终的分析。 24/35（69％）有完全或部分响应（应答），而11/35（31％）具有稳定或进行性疾病（无应答）。总体而言，生存在我们组为8个月（6-11个月95％CI），与谁回答具有比谁没有的那些显著更好地生存的病人。

该反应是由后续成像治疗后8-12周进行测量。响应被列为完全缓解（CR），部分缓解（PR），稳定疾病（SD），进展性疾病（PD）或不能根据RECIST 1.1标准8来评估响应。与CR和PR患者被认为反应，和其他人被列为无反应。次要结果基于肿瘤组织学，复发的大小，和并发的全身治疗包括响应。也分析了协议的副作用和可行性。 <p class="jove_content" fo:keep-together.wit...

Watch this Scientific Journal Video about Endobronchial Ultrasound-guided Intratumoral Injection of Cisplatin for the Treatment of Isolated Mediastinal Recurrence of Lung Cancer at JoVE.com

Endobronchial Ultrasound-guided Intratumoral Injection of Cisplatin for the Treatment of Isolated Mediastinal Recurrence of Lung Cancer

The management of isolated recurrent lung cancer in a previously-irradiated field is challenging. Here, we describe an endobronchial ultrasound (EBUS)-guided cisplatin injection for the management of patients with localized lung cancer recurrence in a previously-radiated field.

支气管内超声引导下顺铂瘤内注射对肺癌纵隔孤立复发的治疗

Isolated hilar and mediastinal recurrence (IMHR) following external beam radiation therapy (EBRT) in patients with lung cancer is common. These patients ...

The overall goal of this procedure is to describe an endobronchial ultrasound or EBUS-guided cisplatin injection for the management of patients with localized lung cancer recurrence in a previously radiated field. This method can help answer key questions in the field of lung cancer treatment about the safety and efficacy of EBUS-guided trans-bronchial intratumoral injection of cisplatin for recurrence of lung cancers in the post-radiated field. The main advantage of this technique is that it provides an alternative treatment option to systemic chemotherapy for patients with isolated, hilar, and mediastinal recurrence of lung cancer.For real-time visualization of hilar, mediastinal, and peribronchial structures for intratumoral cisplatin injection, first intravenously administer dexamethasone and ondansetron to a patient who has abstained from oral food and fluids for at least six hours. Next, induce conscious sedation with intravenous Midazolam and Fentanyl treatment, coupled with the topical application of five milliliters of Lidocaine. Use standard monitoring, including a continuous 3-lead electrocardiogram for heart rate monitoring, continuous pulse oximetry, and respiratory rate measurements.Now locate the target lesion using a convex probe EBUS with a built-in ultrasound probe on a flexible bronchoscope to advance the scope through the vocal cords. When the scope reaches the airways, turn on the EBUS processor and use one to two milliliters of normal saline to inflate the balloon at the tip of the scope. Flex the scope across the airway wall to locate the lesion.Then deploy the 22-gauge EBUS needle through the working channel of the scope and lock the needle into position. Under real-time ultrasound guidance, puncture the tracheobronchial wall and insert the needle into the target lesion. Remove the stylet within the needle and inject 10 milliliters of cisplatin into the lesion.Then retract the needle back into the sheath and inject the needle into a separate area of the lesion for the injection of another 10 milliliters of cisplatin. Remove the needle from the working channel of the scope and suction any additional drug from the distal airways. Then remove the bronchoscope.In this representative study, 8 to 12 weeks after therapy, 69%of the patients were classified as responders and 31%as non-responders, with a median survival of 8 months, 10 months for the responders, and six months for the non-responders, with a significantly higher progression-free survival rate observed in the responders group. While attempting this procedure, it is important to select appropriate patients, and to perform all of the steps in the protocol in a systematic manner. After its development, this technique paved the way for us and other researchers in the field of lung cancer to explore intratumoral chemo and other immunotherapies in animal models and in humans.After watching this video, you should have a good understanding of how to treat mediastinal and hilar recurrence of lung cancer with EBUS-guided intratumoral cisplatin injection.

Research

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Cancer Research

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肺定植法在肺部组织循环肿瘤细胞可视化中的建立

Metastasis is the major cause of cancer death. The role of circulating tumor cells (CTCs) in promoting cancer metastasis, in which lung colonization by ...

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Utilization of Ultrasound Guided Tissue-directed Cellular Implantation for the Establishment of Biologically Relevant Metastatic Tumor Xenografts

超声引导组织定向细胞植入术在生物学相关转移性肿瘤移植中的应用

Preclinical testing of anticancer therapies relies on relevant xenograft models that mimic the innate tendencies of cancer. Advantages of standard ...

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pT3N0M0 胃癌组织石蜡嵌入幻灯片上的弹性染色

The elastic lamina, which is usually located in the sub-mesothelial layer, adjacent to the peritoneum mesothelial cells, is amphiphilic on hematoxylin and ...

Ultrasound-Guided Orthotopic Implantation of Murine Pancreatic Ductal Adenocarcinoma

毛尿胰腺腺腺腺癌超声引导正射植入

The recent success of immune checkpoint blockade in melanoma and lung adenocarcinoma has galvanized the field of immuno-oncology as well as revealed the ...

Perfusion and Inflation of the Mouse Lung for Tumor Histology

肿瘤病理学鼠肺的灌注和膨胀

The ability to evaluate lung histology is critical for the fields of lung cancer research and cancer metastasis. It is equally important to perform ...

Pathological Analysis of Lung Metastasis Following Lateral Tail-Vein Injection of Tumor Cells

肿瘤细胞外侧尾静脉注射后肺转移的病理分析

Metastasis, the primary cause of morbidity and mortality for most cancer patients, can be challenging to model preclinically in mice. Few spontaneous ...

Modeling Brain Metastases Through Intracranial Injection and Magnetic Resonance Imaging

通过颅内注射和磁共振成像对大脑转移进行建模

Metastatic spread of cancer is an unfortunate consequence of disease progression, aggressive cancer subtypes, and/or late diagnosis. Brain metastases are ...

Modeling Brain Metastasis Via Tail-Vein Injection of Inflammatory Breast Cancer Cells

通过炎症性乳腺癌细胞的尾静脉注射模拟脑转移

Metastatic spread to the brain is a common and devastating manifestation of many types of cancer. In the United States alone, about 200,000 patients are ...

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通过超声引导注射产生胰腺癌细胞的原位异种移植物

Pancreatic cancer (PCa) represents one of the deadliest cancer types worldwide. The reasons for PCa malignancy mainly rely on its intrinsic malignant ...

Modeling Brain Metastasis by Internal Carotid Artery Injection of Cancer Cells

通过颈内动脉注射癌细胞模拟脑转移

Brain metastasis is a cause of severe morbidity and mortality in cancer patients. Critical aspects of metastatic diseases, such as the complex neural ...