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.

EBUS-안내 시스플라틴으로 치료 모든 환자에 대한 자료를 검토 하였다. 플로리다 대학의 제도적 검토위원회는이 연구 (# IRB201400823)를 승인했다. 모든 데이터는 전향 적으로 수집하여 후 향적으로 분석 하였다. 다음의 등록 기준을 사용합니다. 1. 환자 선택 <ol><li> 조직 검사에서 확인 된 비 - 소세포 폐암 (NSCLC) 또는 비소 세포 폐암 (SCLC)를 가지며, 조직 학적 확인 된 재발이 18?...

<ol>
	<li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> International Agency for Research on Cancer. , (2012).</li><li>Siegel, R., Ma, J., Zou, Z., Jemal, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cancer+statistics,+2014.">Cancer statistics, 2014.</a> CA Cancer J Clin. 64 (1), 9-29 (2014).</li><li>Jeremic, B., Videtic, G. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chest+reirradiation+with+external+beam+radiotherapy+for+locally+recurrent+non-small-cell+lung+cancer:+a+review.">Chest reirradiation with external beam radiotherapy for locally recurrent non-small-cell lung cancer: a review.</a> Int J Radiat Oncol Biol Phys. 80 (4), 969-977 (2011).</li><li>Perez, C. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+irradiation+technique+and+tumor+extent+in+tumor+control+and+survival+of+patients+with+unresectable+non-oat+cell+carcinoma+of+the+lung:+report+by+the+Radiation+Therapy+Oncology+Group.">Impact of irradiation technique and tumor extent in tumor control and survival of patients with unresectable non-oat cell carcinoma of the lung: report by the Radiation Therapy Oncology Group.</a> Cancer. 50 (6), 1091-1099 (1982).</li><li>Hainsworth, J. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Weekly+docetaxel+with+either+gemcitabine+or+vinorelbine+as+second-line+treatment+in+patients+with+advanced+nonsmall+cell+lung+carcinoma:+Phase+II+trials+of+the+Minnie+Pearl+Cancer+Research+Network.">Weekly docetaxel with either gemcitabine or vinorelbine as second-line treatment in patients with advanced nonsmall cell lung carcinoma: Phase II trials of the Minnie Pearl Cancer Research Network.</a> Cancer. 92 (9), 2391-2398 (2001).</li><li>Grossi, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Phase+II+study+of+irinotecan+and+docetaxel+in+patients+with+previously+treated+non-small+cell+lung+cancer:+an+Alpe-Adria+Thoracic+Oncology+Multidisciplinary+group+study+(ATOM+007).">Phase II study of irinotecan and docetaxel in patients with previously treated non-small cell lung cancer: an Alpe-Adria Thoracic Oncology Multidisciplinary group study (ATOM 007).</a> Lung Cancer. 52 (1), 89-92 (2006).</li><li>Celikoglu, F., Celikoglu, S. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intratumoural+chemotherapy+with+5-fluorouracil+for+palliation+of+bronchial+cancer+in+patients+with+severe+airway+obstruction.">Intratumoural chemotherapy with 5-fluorouracil for palliation of bronchial cancer in patients with severe airway obstruction.</a> J Pharm Pharmacol. 55 (10), 1441-1448 (2003).</li><li>Eisenhauer, E. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=New+response+evaluation+criteria+in+solid+tumours:+revised+RECIST+guideline+(version+1.1).">New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).</a> Eur J Cancer. 45 (2), 228-247 (2009).</li><li>Celikoglu, F., Celikoglu, S. I., York, A. M., Goldberg, E. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intratumoral+administration+of+cisplatin+through+a+bronchoscope+followed+by+irradiation+for+treatment+of+inoperable+non-small+cell+obstructive+lung+cancer.">Intratumoral administration of cisplatin through a bronchoscope followed by irradiation for treatment of inoperable non-small cell obstructive lung cancer.</a> Lung Cancer. 51 (2), 225-236 (2006).</li><li>Celikoglu, S. I., Celikoglu, F., Goldberg, E. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endobronchial+intratumoral+chemotherapy+(EITC)+followed+by+surgery+in+early+non-small+cell+lung+cancer+with+polypoid+growth+causing+erroneous+impression+of+advanced+disease.">Endobronchial intratumoral chemotherapy (EITC) followed by surgery in early non-small cell lung cancer with polypoid growth causing erroneous impression of advanced disease.</a> Lung Cancer. 54 (3), 339-346 (2006).</li><li>Kilburn, J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+mediastinal+relapse+after+treatment+with+stereotactic+body+radiotherapy+or+accelerated+hypofractionated+radiotherapy+for+stage+I/II+non-small-cell+lung+cancer.">Management of mediastinal relapse after treatment with stereotactic body radiotherapy or accelerated hypofractionated radiotherapy for stage I/II non-small-cell lung cancer.</a> J Thorac Oncol. 9 (4), 572-576 (2014).</li><li>Goldberg, E. P., Hadba, A. R., Almond, B. A., Marotta, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intratumoral+cancer+chemotherapy+and+immunotherapy:+opportunities+for+nonsystemic+preoperative+drug+delivery.">Intratumoral cancer chemotherapy and immunotherapy: opportunities for nonsystemic preoperative drug delivery.</a> J Pharm Pharmacol. 54 (2), 159-180 (2002).</li><li>Sandler, A. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Phase+III+trial+of+gemcitabine+plus+cisplatin+versus+cisplatin+alone+in+patients+with+locally+advanced+or+metastatic+non-small-cell+lung+cancer.">Phase III trial of gemcitabine plus cisplatin versus cisplatin alone in patients with locally advanced or metastatic non-small-cell lung cancer.</a> J Clin Oncol. 18 (1), 122-130 (2000).</li><li>Ciotti, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective+evaluation+of+anthracycline-related+early+cardiac+damage:+how+do+we+monitor+it.">Prospective evaluation of anthracycline-related early cardiac damage: how do we monitor it.</a> J Clin Oncol. 19 (22), 4269-4270 (2001).</li><li>Burris, H. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intratumoral+cisplatin/epinephrine-injectable+gel+as+a+palliative+treatment+for+accessible+solid+tumors:+a+multicenter+pilot+study.">Intratumoral cisplatin/epinephrine-injectable gel as a palliative treatment for accessible solid tumors: a multicenter pilot study.</a> Otolaryngol Head Neck Surg. 118 (4), 496-503 (1998).</li><li>Vogl, T. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=CT-guided+intratumoural+administration+of+cisplatin/epinephrine+gel+for+treatment+of+malignant+liver+tumours.">CT-guided intratumoural administration of cisplatin/epinephrine gel for treatment of malignant liver tumours.</a> Br J Cancer. 86 (4), 524-529 (2002).</li><li>Monga, S. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+treatment+of+gastric+cancer+with+intratumoral+cisplatin/epinephrine+injectable+gel:+a+case+report.">Endoscopic treatment of gastric cancer with intratumoral cisplatin/epinephrine injectable gel: a case report.</a> Gastrointest Endosc. 48 (4), 415-417 (1998).</li><li>Monga, S. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intratumoral+therapy+of+cisplatin/epinephrine+injectable+gel+for+palliation+in+patients+with+obstructive+esophageal+cancer.">Intratumoral therapy of cisplatin/epinephrine injectable gel for palliation in patients with obstructive esophageal cancer.</a> Am J Clin Oncol. 23 (4), 386-392 (2000).</li><li>Shepherd, F. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective+randomized+trial+of+docetaxel+versus+best+supportive+care+in+patients+with+non-small-cell+lung+cancer+previously+treated+with+platinum-based+chemotherapy.">Prospective randomized trial of docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy.</a> J Clin Oncol. 18 (10), 2095-2103 (2000).</li><li>Hanna, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Randomized+phase+III+trial+of+pemetrexed+versus+docetaxel+in+patients+with+non-small-cell+lung+cancer+previously+treated+with+chemotherapy.">Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy.</a> J Clin Oncol. 22 (9), 1589-1597 (2004).</li></ol>

<html> 우리의 원고는 더 많은 방사선이 옵션을 선택하지 않습니다 누구에 환자의 폐암의 고립 된 종격동 및 폐문 재발의 관리에 초점을 맞추고있다. IMHR의 발생 빈도는 약 9 % (11)이다. 다른 치료 방법은 고식적 항암 화학 요법, 더 많은 외부 빔 방사선 치료, 또는지지 요법 및 감시를 포함하여, 이러한 환자에서 시도되고있다. 우리 기관에서, 우리는 기관지 내시경에 의해 유도 종양...

폐암은 모든 암 관련 사망의 5 일에 대한 남성과 여성 모두와 계정에서 전 세계적으로 가장 널리 퍼진 암이다. 그것은 0.87 1, 2의 경우 치사율이 있습니다. 초기 치료 후 재발 폐암 환자에서 대부분의 사망자를 차지한다. 재발 성 폐암에 대한 치료 옵션이 제한됩니다. 재발 성 폐암은 더 개입 (3)에 수용과 관용의 가능성을 감소 모두의 삶의 질에 상당한 교사 단선에 상당한 손상에 이르게 추가지지 요법이 필요합니다. 비소 세포 폐암 환자의 약 30 %는 방사선 사 후 국소 재발이있다. 이들 환자에 대한 치료 옵션은 제한적이며 10 % (5), (6)의 대물 응답 속도가 전신 화학 요법을 포함한다.반복 흉부 방사선이 가능하지만, 그 목적 완화 및 증상 완화 주로 연구되었다 질병 관해 3에 사용되지 않았다. 우리 기관에서, 기관지 내시경을 통해 액세스 격리 된 종격동 및 폐문 재발 (IMHR) 모든 환자는 시스플라틴의 기관지 종양 내 주사 (ITC)를 -guided 기관지 초음파 (EBUS)로 처리 하였다. 전신 화학 요법 및 / 또는 외부 빔 방사선 요법 (EBRT)와 동시 치료는 치료 종양 &#39;재량권에 따라시켰다. 이 원고는 안전성, 유효성, 타당성, 그리고 우리의 기관에서 사용되는 프로토콜에 대한 자세한 방법을 강조한다.

<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

폐암 환자의 격리 된 폐문 및 외부 빔 방사선 요법 (EBRT) 다음 종격동 재발 (IMHR)이 일반적이다. 이 환자들은 많은 치료 옵션이없는 일반적으로 고식적 항암 화학 요법 또는 최선의지지 요법을 제공됩니다. 기관지 초음파 (EBUS)는 시스플라틴의 종양 내 주입을 -guided (ITC)는 이러한 환자에 대한 새로운 접근 방식이다. 절차는 수면 마취 하에서 수행된다. 병변은 EBUS를 사용하여 기관지에 위치되고, 22 게이지 바늘 EBUS 범위의 워킹 채널을 통해 전진 위치에 고정된다. 초음파 안내 하에서, 기관지 벽의 천공 바늘은 표적 병변에 이동된다. 니들 탐침이어서 제거되고 시스플라틴은 (40 밀리그램 / 40 mL)을 환부에 주입된다. 한 두 사이트는 세션 당 처리됩니다. 절차의 세부 사항은 용지의 프로토콜 섹션에 설명되어 있습니다. 우리 센터에서 50 사이트는 36 명에서 치료를 받았다(19 남성, 17 여성). 우리의 코호트의 평균 연령은 61.9 ± 8.5 세였다. 우리는 35 명, 41 사이트에 최종 분석을 수행 하였다. 35분의 11 (31 %)이 안정 또는 진행성 질환 (비 대응)을 가지고, 반면 35분의 24 (69 %)은 전체 또는 부분 반응 (대응)를 가지고 있었다. 전반적으로, 우리 그룹의 생존하지 않았다 것보다 훨씬 더 나은 생존을 갖는 반응했다 환자 8 개월 (6-11개월의 95 % CI)이었다.

응답은 8~12주 치료 후 후속 촬상하여 측정 하였다. 반응은 완전 관해 (CR), 부분 관해 (PR), 안정한 질환 (SD), 진행성 질환 (PD), 또는 8 RECIST 1.1 기준에 기초하여 응답을 평가할 수없는 것으로 분류 하였다. CR과 PR 환자는 조치로 간주하고, 나머지는 비 반응 군으로 분류 하였다. 이차 결과는 종양의 조직 학적, 재발의 크기, 동시 전신 요법에 따라 응답을 포함. ...

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.

기관지 폐암의 고립 된 종격동 재발의 치료에 시스플라틴의 종양 내 주입을 초음파 유도

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

JoVE Journal

Cancer Research

The Establishment of a Lung Colonization Assay for Circulating Tumor Cell Visualization in Lung Tissues

순환 종양 세포 시각화 폐 조직에 대 한 폐 식민 분석 결과의 설립

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

연구

암 연구학

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

초음파의 이용 가이드 생물학 관련 전이성 종양 Xenografts의 설립을 위한 세포 이식 조직 감독

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

Elastic Staining on Paraffin-embedded Slides of pT3N0M0 Gastric Cancer Tissue

pT3N0M0 위암 조직의 파라핀 내장 슬라이드에 탄성 염색

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

뮤린 췌장 연성 선암의 초음파 유도 정형 외 이식

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

종양 연고학을 위한 마우스 폐의 관류 및 인플레이션

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

종양 세포의 측면 꼬리 정맥 주입 다음 폐 전이의 병리학 적 분석

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

두개 내 주입 및 자기 공명 이미징을 통해 뇌 전이를 모델링

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

염증성 유방암 세포의 꼬리 정맥 주입을 통한 뇌 전이 모델링

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 ...

Generation of an Orthotopic Xenograft of Pancreatic Cancer Cells by Ultrasound-Guided Injection

초음파 유도 주사에 의한 췌장암 세포의 동종 이종이의 생성

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

암세포의 내경동맥 주입에 의한 뇌전이 모델링

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