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.

Les données sur tous les patients traités par cisplatine EBUS-guidée ont été examinés. La commission d&#39;examen institutionnel à l&#39;Université de Floride a approuvé cette étude (# IRB201400823). Toutes les données ont été recueillies de façon prospective et analysés rétrospectivement. Utilisez les critères d&#39;inscription suivants. 1. Sélection des patients <ol><li> Sélectionnez les patients âgés entre 18 et 80 ans qui ont un non-petit cancer confirmée par biop...

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<html> Notre manuscrit se concentre sur la gestion des récurrences médiastinaux et hilaires isolés de cancer du poumon chez les patients dont plus de rayonnement est pas une option. L&#39;incidence de l&#39; IRSM est d&#39; environ 9% 11. Différentes options de traitement ont été testées chez ces patients, y compris la chimiothérapie palliative, plus de la radiothérapie par faisceau externe, ou les soins de soutien et de surveillance. Dans notre institution, nous traitons ces patients ave...

Le cancer du poumon est le cancer le plus répandu dans le monde entier le chez les hommes et les femmes et les comptes de 1 à 5 de tous les décès liés au cancer. Il a un taux de létalité de 0,87 1, 2. Récidive après le traitement initial représente la plupart des décès chez les patients atteints d&#39;un cancer du poumon. Les options thérapeutiques pour le cancer du poumon récurrentes sont limitées. Cancer du poumon récurrent conduit également à une altération significative de la qualité de vie et à l&#39; épuisement significatif des aidants et nécessite des soins de soutien supplémentaire, qui diminue la probabilité d&#39;acceptation et de tolérance à d&#39; autres interventions 3. Près de 30% des patients atteints de NSCLC ont récidive locorégionale après rayonnement 4. Les options de traitement pour ces patients sont limitées et incluent la chimiothérapie systémique, qui a un taux de réponse objective de 10% seulement 5, 6.Bien que la radiothérapie thoracique répétition est possible, il a été étudié principalement à des fins palliatives et le soulagement des symptômes et n&#39;a pas été utilisé pour la maladie de rémission 3. Dans notre institution, tous les patients avec récidive isolée médiastinale et hilaire (IRSM) accessibles par bronchoscopie ont été traités avec une échographie endobronchique (EBUS) -Visite injection intratumorale transbronchique de cisplatine (ITC). Traitement concomitant avec la chimiothérapie systémique et / ou de la radiothérapie par faisceau externe (EBRT) a été autorisé selon les discrétions des oncologues traitants. Ce manuscrit met en évidence l&#39;innocuité, l&#39;efficacité, la faisabilité et les méthodes détaillées du protocole utilisé dans notre institution.

<table border="0" cellpadding="0" cellspacing="0" width="261">
	<tbody>
		<tr height="20">
			<td colspan="2" height="20" style="height:20px;width:261px;">Bronchoscope</td>
		</tr>
		<tr height="20">
			<td colspan="2" height="20" style="height:20px;">22 Guage olympus EBUS needle</td>
		</tr>
		<tr height="20">
			<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

hilaire Isolés et récidive médiastinale (de IRSM) après un traitement de radiothérapie externe (EBRT) chez les patients atteints de cancer du poumon est commun. Ces patients ne disposent pas de nombreuses options de traitement et sont généralement offerts chimiothérapie palliative ou meilleurs soins de soutien. échographie endobronchique (EBUS) -Visite injection intratumorale de cisplatine (ITC) est une nouvelle approche pour ces patients. La procédure est réalisée sous sédation consciente. La lésion est située avec une bronchoscopie utilisant EBUS, et une aiguille de EBUS calibre 22 est avancé à travers le canal de travail de la portée et verrouillé en position. Sous guidage échographique, la paroi de l&#39;arbre trachéo-bronchique est percé et l&#39;aiguille est déplacée dans la lésion cible. Le mandrin d&#39;aiguille est ensuite retirée et le cisplatine (40 mg / 40 ml) est injecté dans la lésion. Un à deux sites sont traités par session. Les détails de la procédure sont décrits dans la partie protocole du papier. Dans notre centre, 50 sites ont été traités chez 36 patients(19 hommes, 17 femmes). L&#39;âge moyen de notre cohorte était de 61,9 ± 8,5 ans. Nous avons effectué des analyses finales sur 35 patients et 41 sites. 24/35 (69%) ont eu une réponse complète ou partielle (répondeurs), alors que 11/35 (31%) avaient une maladie stable ou progressive (non-répondeurs). Dans l&#39;ensemble, la survie de notre groupe était de 8 mois (IC à 95% des 6-11 mois), avec les patients qui ont répondu de manière significative ayant une meilleure survie que ceux qui ne l&#39;ont pas.

La réponse a été mesurée par imagerie suivi 8-12 semaines après le traitement. La réponse a été classée comme une rémission complète (CR), partielle rémission (PR), une maladie stable (SD), une maladie progressive (PD), ou incapable d&#39;évaluer la réponse en fonction des critères RECIST 1.1 8 critères. Les patients atteints de CR et PR ont été considérés comme répondeurs, et les autres ont été classés comme non-répondeurs. Les résultats...

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.

Endobronchique guidée par échographie injection intratumorale de cisplatine pour le traitement des Isolated médiastinale Récurrence du cancer du poumon

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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