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.

Uppgifter om alla patienter som behandlas med EBUS styrd cisplatin granskades. Den institutionella prövningsnämnd vid University of Florida godkänt denna studie (# IRB201400823). Alla data prospektivt samlat och i efterhand analyseras. Använd följande inskrivning kriterier. 1. Patient Val <ol><li> Välj patienter i åldrarna 18 och 80 år som har en biopsi bekräftade icke-småcellig lungcancer (NSCLC) eller småcellig lungcancer (SCLC) och har en patologiskt bekräftade återfall. An...

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<html> Vår manuskript fokuserar på hanteringen av isolerade mediastinum och hilar återfall av lungcancer för patienter hos vilka mer strålning är inte ett alternativ. Incidensen av IMHR är ca 9% 11. Olika behandlingsalternativ har prövats i dessa patienter, inklusive palliativ kemoterapi mer extern strålbehandling, eller understödjande behandling och övervakning. Vid vår institution, vi behandla dessa patienter med intratumoral cisplatin styrs av bronkoskopi. <p class="jove_content...

Lungcancer är den vanligaste cancern i världen i både män och kvinnor och står för en i fem av alla cancerrelaterade dödsfall. Den har ett fall dödlighet på 0,87 1, 2. Återfall efter initial behandling svarar för de flesta dödsfall hos patienter med lungcancer. Terapeutiska alternativ för återkommande lungcancer är begränsade. Återkommande lungcancer leder också till betydande försämring i livskvalitet och betydande vårdgivare utbrändhet och kräver ytterligare stödjande vård, som alla minskar sannolikheten för acceptans och tolerans mot ytterligare insatser 3. Nästan 30% av patienter med icke-småcellig lungcancer har lokoregional återfall efter strålning 4. Behandlingsalternativ för dessa patienter är begränsade och innefattar systemisk kemoterapi, som har en objektiv svarsfrekvens på endast 10% 5, 6.Även upprepa bröst strålning är möjlig, har det undersökts främst i palliativt syfte och symtomlindring och har inte använts för sjukdomsremission 3. Vid vår institution, var alla patienter med isolerad mediastinum och hilar återfall (IMHR) tillgängliga genom bronkoskopi behandlas med en endobronkiala ultraljud (EBUS) -Guidad Transbronkiell intratumoral injektion av cisplatin (ITC). Samtidig behandling med systemisk kemoterapi och / eller extern strålbehandling (EBRT) fick enligt behandlings onkologer handlingsfrihet. Detta manuskript belyser säkerhet, effektivitet, genomförbarhet och detaljerade metoder för det protokoll som används vid vår 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>
		</tr>
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			<td colspan="2" height="20" style="height:20px;">22 Guage olympus EBUS needle</td>
		</tr>
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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

Isolerad hilar och mediastinum återfall (IMHR) efter extern strålbehandling (EBRT) i patienter med lungcancer är vanligt. Dessa patienter har inte många behandlingsalternativ och vanligtvis erbjuds palliativ kemoterapi eller bästa understödjande behandling. Endobronkial ultraljud (EBUS) -Guidad intratumoral injektion av cisplatin (ITC) är en ny metod för dessa patienter. Förfarandet utförs under sedering. Lesionen ligger med en bronkoskopi med hjälp EBUS, och en 22-gauge EBUS nål förs fram genom arbetskanal av omfattningen och i låst läge. Under ultraljud, är väggen i trakeobronkiala trädet punkterade och nålen flyttas till målet lesionen. Nålen mandrängen avlägsnas därefter och cisplatin (40 mg / 40 ml) injiceras i lesionen. En till två platser behandlas per session. Uppgifter om förfarandet beskrivs i protokollet avsnitt av papper. Vid vårt center, var 50 platser behandlas 36 patienter(19 hanar, 17 honor). Medelåldern för vår kohort var 61,9 ± 8,5 år. Vi utförde slutliga analyserna på 35 patienter och 41 platser. 24/35 (69%) hade fullständig eller partiell respons (responders), medan 11/35 (31%) hade en stabil eller progredierande sjukdom (icke-responders). Sammantaget överlevnad i vår grupp var 8 månader (95% CI av 6-11 månader), med patienter som svarade med signifikant bättre överlevnad än de som inte gjorde det.

Responsen mättes genom uppföljning avbildning 8-12 veckor efter behandlingen. Svaret klassificerades som fullständig remission (CR), partiell remission (PR), stabil sjukdom (SD), progressiv sjukdom (PD), eller inte bedöma svar baserat på RECIST 1.1 kriterier 8. Patienter med CR och PR ansågs responders, och de andra klassificerades som icke-responders. Sekundära utfall ingår svar baserat på tumörhistologi, storlek för återfall, och samtidig systemisk b...

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.

Endobronkiala Ultraljud-guidad intratumoral injektion av cisplatin för behandling av isolerade mediastinum Återkommande lungcancer

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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