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.

Data om alle patienter behandlet med eBUS-guidet cisplatin blev gennemgået. Den institutionelle Review Board på University of Florida godkendt denne undersøgelse (# IRB201400823). Alle data blev prospektivt indsamlet og efterfølgende analyseret. Brug følgende tilmelding kriterier. 1. Patient Selection <ol><li> Vælg patienter i alderen 18 og 80 år, der har en biopsibekræftet ikke-småcellet lungekræft (NSCLC) eller småcellet carcinom (SCLC) og har en patologisk-bekræftet gentagel...

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<html> Vores manuskript fokuserer på styring af isolerede mediastinale og hilar gentagelser af lungekræft for patienter, hvor mere stråling er ikke en mulighed. Forekomsten af IMHR er ca. 9% 11. Forskellige behandlingsmuligheder er blevet prøvet i disse patienter, herunder palliativ kemoterapi, mere ekstern strålebehandling terapi eller understøttende behandling og overvågning. På vores institution, vi behandler disse patienter med intratumoral cisplatin styret af bronkoskopi. <p class...

Lungekræft er den mest udbredte kræft på verdensplan i både mænd og kvinder og regnskab for en i 5 af alle kræftrelaterede dødsfald. Det har en dødelighed på 0,87 1, 2. Gentagelse efter indledende behandling tegner sig for de fleste dødsfald hos patienter med lungekræft. Terapeutiske muligheder ved tilbagevendende lungekræft er begrænsede. Tilbagevendende lungekræft fører også til væsentlig forringelse i livskvalitet og betydelig pårørende udbrændthed og kræver yderligere understøttende behandling, som alle mindske sandsynligheden for accept og tolerance over for yderligere tiltag 3. Næsten 30% af patienter med NSCLC har locoregional tilbagefald efter stråling 4. Behandlingsmuligheder for disse patienter er begrænsede og omfatter systemisk kemoterapi, som har en objektiv responsrate på kun 10% 5, 6.Selvom gentage brystet stråling er muligt, er det blevet undersøgt primært til palliativ formål og symptomlindring og er ikke blevet brugt til sygdom remission 3. På vores institution, blev alle patienter med isolerede mediastinale og hilar recidiv (IMHR) tilgængelige via bronkoskopi behandlet med et endobronkial ultralyd (eBUS) -Guidede transbronkial intratumoral injektion af cisplatin (ITC). Samtidig behandling med systemisk kemoterapi og / eller ekstern strålebehandling terapi (EBRT) var tilladt som pr de behandlende onkologer &#39;skøn. Dette håndskrift fremhæver sikkerhed, effektivitet, gennemførlighed, og detaljerede metoder den anvendte protokol til vores institution.

<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

Isoleret hilar og mediastinale recidiv (IMHR) efter ekstern strålebehandling terapi (EBRT) hos patienter med lungekræft er fælles. Disse patienter har ikke mange behandlingsmuligheder og er normalt tilbydes palliativ kemoterapi eller bedste understøttende behandling. Endobronkial ultralyd (eBUS) -Guidede intratumoral injektion af cisplatin (ITC) er en ny tilgang til disse patienter. Proceduren udføres under bevidst sedation. Læsionen er placeret med en bronkoskopi hjælp eBUS, og en 22-gauge eBUS nål fremføres gennem arbejdskanalen af ​​anvendelsesområdet og låses i position. Ved hjælp af ultralyd er væggen af ​​tracheobronchial tree punkteret, og nålen bevæges ind i målet læsion. Nålen stiletten fjernes derefter og cisplatin (40 mg / 40 ml) injiceres i læsionen. En til to steder behandles per session. Detaljer for proceduren er beskrevet i afsnittet papir protokol. På vores center, blev 50 lokaliteter behandlet i 36 patienter(19 hanner, 17 hunner). Gennemsnitsalderen for vores kohorte var 61,9 ± 8,5 år. Vi udførte endelige analyser på 35 patienter og 41 steder. 24/35 (69%) havde fuldstændig eller delvis respons (respondenter), mens 11/35 (31%) havde stabil eller progressiv sygdom (ikke-respondenter). Samlet set overlevelse i vores gruppe var 8 måneder (95% CI af 6-11 måneder), med patienter, der responderede har væsentligt bedre overlevelse end dem, der ikke gjorde.

Responset blev målt ved opfølgning billeddannelse 8-12 uger efter terapi. Svaret blev klassificeret som komplet remission (CR), partiel remission (PR), stabil sygdom (SD), progressiv sygdom (PD), eller ude af stand til at vurdere respons baseret på RECIST 1.1 kriterier 8. Patienter med CR og PR blev betragtet respondenter, og de andre blev klassificeret som ikke-respondenter. Sekundære resultater indgår respons baseret på tumor histologi, størrelse af tilba...

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.

Endobronchial Ultralyd-vejledt intratumoral Injektion af cisplatin til behandling af isoleret mediastinum Gentagelse af lungekræft

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.

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