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.

Se revisaron los datos de todos los pacientes tratados con cisplatino USEB. La junta de revisión institucional de la Universidad de Florida aprobó este estudio (# IRB201400823). Todos los datos se recogen de forma prospectiva y analizados retrospectivamente. Utilice los siguientes criterios de inscripción. 1. Selección de los pacientes <ol><li> Seleccionar los pacientes entre las edades de 18 y 80 años que tienen un cáncer confirmada por biopsia de pulmón no microcítico (CPNM) o ca...

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<html> Nuestro manuscrito se centra en la gestión de las recurrencias mediastínicas e hiliares aislados de cáncer de pulmón para los pacientes en los que más radiación no es una opción. La incidencia de la GIRH es de aproximadamente 9% 11. Diferentes opciones de tratamiento han sido juzgados en estos pacientes, incluyendo la quimioterapia paliativa, más radioterapia de haz externo, o cuidados de apoyo y vigilancia. En nuestra institución, tratamos a estos pacientes con cisplatino intratum...

El cáncer de pulmón es el cáncer más frecuente en todo el mundo, tanto en hombres y mujeres y de las cuentas de 1 de cada 5 de todas las muertes relacionadas con el cáncer. Tiene una tasa de letalidad del 0,87 1, 2. La recurrencia después del tratamiento inicial da cuenta de la mayoría de las muertes en pacientes con cáncer de pulmón. Las opciones terapéuticas para el cáncer de pulmón recurrentes son limitadas. Cáncer de pulmón recurrente también conduce a un deterioro significativo de la calidad de vida y al agotamiento del cuidador significativa y requiere la atención de apoyo adicional, todo lo cual disminuye la probabilidad de aceptación y tolerancia de más intervenciones 3. Casi el 30% de los pacientes con NSCLC tiene recurrencia locorregional después de la radiación 4. Las opciones de tratamiento para estos pacientes son limitados e incluyen quimioterapia sistémica, que tiene una tasa de respuesta objetiva de sólo el 10% 5, 6.Aunque la radiación en el pecho de repetición es factible, se ha estudiado principalmente con fines paliativos y alivio de los síntomas y no se ha utilizado para la remisión de la enfermedad 3. En nuestra institución, todos los pacientes con recidiva aislada del mediastino e hiliares (GIRH) accesibles a través de la broncoscopia se trataron con una ecografía endobronquial (EEB) guiada por inyección intratumoral transbronquial de cisplatino (ITC). El tratamiento concomitante con quimioterapia sistémica y / o radioterapia de haz externo (RHE) se le permitió según discreciones los oncólogos que tratan. Este manuscrito destaca la seguridad, la eficacia, la viabilidad y los métodos detallados del protocolo utilizado en nuestra institución.

<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

hiliar aislada y la recurrencia del mediastino (GIRH) después de la radioterapia de haz externo (RHE) en pacientes con cáncer de pulmón es común. Estos pacientes no tienen muchas opciones de tratamiento y por lo general se ofrecen quimioterapia paliativa o mejor cuidado de apoyo. ecografía endobronquial (EEB) guiada por la inyección intratumoral de cisplatino (ITC) es un enfoque novedoso para estos pacientes. El procedimiento se realiza bajo sedación consciente. La lesión se encuentra con una broncoscopia utilizando EEB, y una aguja de calibre 22 EEB se hace avanzar a través del canal de trabajo del ámbito de aplicación y bloqueado en su posición. Bajo la guía del ultrasonido, la pared del árbol traqueobronquial y se pincha la aguja se mueve dentro de la lesión a tratar. Después se retira el estilete de la aguja y cisplatino (40 mg / 40 ml) se inyecta en la lesión. De una a dos sitios son tratados por sesión. Los detalles del procedimiento se describen en la sección Protocolo de papel. En nuestro centro, 50 sitios fueron tratados en 36 pacientes(19 varones, 17 mujeres). La edad media de nuestra cohorte fue de 61,9 ± 8,5 años. Se realizó el análisis final en 35 pacientes y 41 sitios. 24/35 (69%) tuvieron una respuesta completa o parcial (respondedores), mientras que 11/35 (31%) tenían enfermedad estable o progresiva (no respondedores). En general, la supervivencia en nuestro grupo fue de 8 meses (IC del 95% de 6-11 meses), con pacientes que respondieron que tienen una supervivencia significativamente mayor que los que no lo hicieron.

La respuesta se midió por imágenes de seguimiento de 8-12 semanas después de la terapia. La respuesta fue clasificada como la remisión completa (CR), remisión parcial (PR), enfermedad estable (SD), enfermedad progresiva (PD), o es incapaz de evaluar la respuesta sobre la base de criterios RECIST 1.1 8. Los pacientes con CR y PR fueron considerados respondedores, y los otros fueron clasificados como no respondedores. Los resultados secundarios incluyeron respu...

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.

Endobronquial guiada por ultrasonografía inyección intratumoral de cisplatino para el tratamiento de los aislada mediastinal La recurrencia de cáncer de pulmón

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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