Name: endobronchial ultrasound-guided intratumoral injection of cisplatin for the treatment of isolated mediastinal recurrence of lung cancer
Uploaded: 2017-02-12T14:00:00.000+00:00
Duration: 4 min 4 s
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 rehberliğinde sisplatin ile tedavi edilen tüm hastalarda ilgili veriler incelendi. Florida Üniversitesi&#39;nde kurumsal inceleme kurulu bu çalışmayı (# IRB201400823) onayladı. Tüm veriler prospektif olarak toplanmış ve geriye dönük olarak analiz edildi. Aşağıdaki kayıt ölçütleri kullanın. 1. Hasta Seçimi <ol><li> biyopsi ile doğrulanmış küçük hücreli olmayan akciğer kanseri (KHDAK) ya da küçük hücreli akciğer kanseri (KHAK) ve patolojik teyit nüks 18 ve 80 yaşları arasındaki seçin hastalar. 6 ay veya daha uzun süre hiler ve mediastinal yapılara radyasyon en az 50 gy almış hastaların kayıt yaptırmaktadır. EBUS ve uzak metastaz erişilebilir hiler, mediastinal sınırlı nüks hastaları ve peribronşiyal yapıları (lenf nodları, nodül ve kitleleri) içerir. </li><li> çok disiplinli bir göğüs onkoloji tümör kuruluna tüm bu hasta sunuldu ve in ile devam üzerinde fikir birliği elde etmekdiğer lokalize tedavi seçeneklerinin eksikliği nedeniyle tratumoral sisplatin. EBUS rehberliğinde ITC ile devam etme kararı kurumsal göğüs onkoloji tümör kurulu ortak öneri olmalıdır. </li></ol> 2. Endobronşiyal Ultrason (EBUS) Sisplatin, Enjeksiyon -Güdümlü <ol><li> ITC için hiler, mediastinal ve peribronşiyal yapıların esnek bronkoskop ultrason probu dahili ve sağlayan gerçek zamanlı görselleştirme sahip dışbükey bir prob EBUS kullanın. </li><li> Hastalar işlemden önce en az 6 saat süreyle ağızdan gıda ve sıvıların kaçınmaları emin olun. </li><li> Daha önce yayınlanmış literatürde 9, 10 göre, oturum başına 40 mg&#39;lık bir maksimum doz 1 mg / mL&#39;lik bir konsantrasyonda bir sulu çözelti sisplatin oluşturun. Kullanımdan hemen önce% 0.9 NaCI çözeltisi içinde liyofilize sisplatin tozu çözülür. </li><li> damardan başlar de deksametazon 10 mg ve ondansetronun 8 mgprosedürün ning bulantı önlemek için. </li><li> intravenöz midazolam ve fentanil ile bilinçli sedasyon ile yordamı gerçekleştirin (IV). prosedüründen önce% 4 lidokain nebülizasyon 5 mL şeklinde topik anestezi kullanın. </li><li> midazolam, 2 mg fentanil ve 50 ug IV enjeksiyonu ile başlayın. hastaya her 1-2 dakikada bir yeniden değerlendirmeye ve elde etmek ve bilinçli sedasyon devam etmek için ek 1 mg midazolam ve 25 ug fentanil bolus vermek (minimal depresif bilinç hasta sürekli ve bağımsız solunum yolunu korumak mümkün olduğu şekilde, koruyucu refleksleri korumak, ve sözlü komutlara ve fiziksel stimülasyon) duyarlı kalır. sırasıyla, fentanil ve midazolam, 200 ug ve 10 mg maksimum izin verilen doz aşmayın. </li><li> Bir kalp hızı izleme sürekli 3-kurşun elektrokardiyogram, sürekli pulse oksimetre ve solunum hızı ölçümleri dahil, standart izleme kullanın. Yerel ANEST sağlamaklerine ve gerektiği gibi tamamlayıcı O 2. </li><li> solunum yollarında ses tellerinin sayesinde kapsamını ilerlemek. Belirlemek ve hedef lezyon bulun. </li><li> EBUS işlemci açın ve serum fizyolojik 1-2 mL kullanarak kapsam ucundaki balonu şişirmek. Hava yolu duvarı boyunca kapsamını Flex ve lezyon bulun. Lezyonun yeri CT / PET bulguları bağlıdır, ancak ortak sitelerin bazıları subkarinal alanı, sağ ve sol paratrakeal alanları ve sağ ve sol hiler alanları bulunmaktadır. </li><li> kapsam çalışma kanalından bir kılıf içinde yer alır 22 G EBUS iğne dağıtmak ve konumda kilitleyin. NOT: Enjeksiyon sitesi için kesin bir cerrahi koordinatlar olmasına rağmen, yaygın olarak tedavi edilen bazı sitelerin sadece (medial sağ ve sol ana bronş kavşağında) subkarinal, yanal sağ ana bronş doğru paratrakeal (dahil sol paratrakeal) sağ üst lob deliği üzerindede ((sağ üst lob açıklığı altında yanal proksimal bronş intermedius de) sağ hiler ve sol hiler (distal trakea kavşak ve aort kemer ve sol pulmoner arter arasında sol ana at) sol üst lob birleşim ve sol alt lob bronşlar). </li><li> Gerçek zamanlı ultrasonografi eşliğinde, trakeobronşiyal duvar delinme ve hedef lezyon iğne yerleştirin. iğne içinde stile kaldırmak ve bir seferde lezyon 10 mL (1 mg / sisplatin mL) içine sisplatin enjekte. tabaka içinde iğne geri çekin. </li><li> boyunca ilaç enjeksiyonu kolaylaştırmak için farklı yerlerde seans başına dört delikler her lezyon davranın. ponksiyon başına sisplatin 10 mg enjekte edilir. </li><li> seans başına iki lezyonlara birini davranın. birden fazla lezyon oturum başına tedavi edilirse, 40 mg aşmayan oturum başına toplam doz, sisplatin 20 mg her site enjekte edilir. </li><li> worki iğne çıkarınkapsam ng kanalı. </li><li> Distal hava yollarına herhangi bir ek ilaç emme ve bronkoskop çıkarın. </li><li> Hastalar hastane protokolüne uygun olarak kurtarmak ve aynı gün bunları bitmesini sağlayın. </li><li> 4 haftalık toplam haftada bir kez (2.7-2.13 adımlar) sisplatin enjeksiyon tekrar (1. ve 8. günlerde, 15 ve 22). NOT: Bir kez işlendikten sonra, belirli bir lezyon sonraki karşılaşmalar üzerine ITC ile İşleme düşünülmemelidir. </li></ol> 3. Post-enjeksiyon <ol><li> bir takip toraks bilgisayarlı tomografi (BT) veya pozitron emisyon tomografisi (PET / BT) ile yanıtı değerlendirmek 8-12 haftalık son tedavi seansından sonra tarayın. Tedavinin yerinde nüks ve mediasten, hilusta nüks veya supraklaviküler fossa gibi bölgesel nüks olarak lokal nüks tanımlayın. </li></ol>

<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>

The authors have nothing to disclose.

<html> Bizim el yazması fazla radyasyon bir seçenek değildir hastalar için akciğer kanserinin izole mediastinal ve hiler nüks yönetimine odaklanmaktadır. IMHR insidansı yaklaşık% 9 11&#39;dir. Farklı tedavi seçenekleri palyatif kemoterapi, daha fazla harici ışın radyasyon tedavisi veya destekleyici bakım ve gözetim dahil olmak üzere, bu hastalarda denenmiştir. Kurumumuzda, biz bronkoskopi ile yönlendirilen intratümöral sisplatin ile bu hastaların tedavisinde. <p class="...

Akciğer kanseri tüm kanser bağlı ölümlerin 5 içinde 1 için hem erkek hem de kadın ve hesaplarına dünya çapında en yaygın kanser türüdür. Bu 0.87 1, 2 vaka ölüm oranı vardır. İlk tedaviden sonra nüks akciğer kanseri olan hastalarda en ölümlerin oluşturmaktadır. Tekrarlayan akciğer kanseri için tedavi seçenekleri sınırlıdır. Tekrarlayan akciğer kanseri daha da müdahaleler 3 kabul ve hoşgörü olasılığını azaltmak bütün bunlar, yaşam kalitesinin ve önemli bakıcı tükenmişlik önemli bozulma yol açar ve ek destekleyici bakım gerektirir. KHDAK hastalarının yaklaşık% 30&#39;u radyasyon 4 sonra lokal nüks var. Bu hastalar için tedavi seçenekleri sınırlıdır ve sadece% 10 5, 6 objektif yanıt oranı sistemik kemoterapi içerir.Tekrar göğüs radyasyon mümkün olmasına rağmen, bu palyatif amaçlarla ve belirtilerin giderilmesi için ağırlıklı olarak çalışılmış ve hastalık remisyon 3 için kullanılan olmamıştır. Kurumumuzda, bronkoskopi üzerinden erişilebilir izole mediastinal ve hiler nüks (IMHR) tüm hastalar sisplatin transbronşial tümör içi enjeksiyon (ITC) -Güdümlü endobronşiyal ultrason (EBUS) ile tedavi edildi. sistemik kemoterapi ve / veya eksternal radyoterapi (EBRT) ile eş zamanlı tedavi tedavi onkolog &#39;takdirine göre izin verildi. Bu el yazması güvenliği, etkinliği, fizibilite ve bizim kurumda kullanılan protokol ayrıntılı yöntemler vurgulamaktadır.

<table><tbody><tr><td>Bronchoscope</td><td></td><td></td><td></td></tr><tr><td>22 Guage olympus EBUS needle</td><td></td><td></td><td></td></tr><tr><td>40 g of cisplatin in 40 mL of normal saline</td><td></td><td></td><td></td></tr></tbody></table>

endobronchial ultrasound-guided intratumoral injection of cisplatin for the treatment of isolated mediastinal recurrence of lung cancer

Akciğer kanserli hastalarda izole hiler ve eksternal radyoterapi (EBRT) aşağıdaki mediastinal nüks (IMHR) yaygındır. Bu hastalar birçok tedavi seçeneği yoktur ve genellikle palyatif kemoterapi ya da en iyi destekleyici bakım sunulmaktadır. Endobronşiyal ultrason (EBUS) sisplatin tümör içi enjeksiyon -Güdümlü (ITC) bu hastalar için yeni bir yaklaşımdır. prosedür bilinçli sedasyon altında yapılır. lezyon EBUS kullanarak bronkoskopi ile bulunur ve bir 22-gauge EBUS iğne kapsamında çalışma kanalından gelişmiş ve pozisyonda kilitlenir. ultrasonografi eşliğinde, trakeobronşiyal ağacın duvar delinir ve iğne hedef lezyonun taşınır. İğne stile daha sonra çıkarılır ve sisplatin (40 mg / 40 mi) bir lezyon içine enjekte edilir. Bir iki site seans başına tedavi edilir. prosedürün ayrıntıları kağıt protokolü bölümünde açıklanmıştır. Merkezimizde, 50 siteler 36 hastada tedavi edildi(19 erkek, 17 kadın). Bizim kohort yaş ortalaması 61.9 ± 8.5 yıl idi. Biz 35 hasta ve 41 sitelerinde son analizler gerçekleştirilmiştir. 11/35 (% 31) stabil veya progresif hastalığı (non-yanıt) sahipken 24/35 (% 69), tam ya da kısmi yanıt (yanıt) vardı. Genel olarak, bizim grupta sağkalım vermedi olanlardan çok daha iyi sağkalım sahip yanıtladı hastalarda 8 ay (6-11 ay% 95 CI), oldu.

yanıtı 8-12 hafta tedaviden sonra takip görüntülemesi ile ölçüldü. Yanıtı tam remisyon (CR), kısmi remisyon (PR), stabil hastalık (SD), progresif hastalığı (PH), ya da RECIST 1.1 kriter 8 dayalı yanıtı değerlendirmek mümkün olarak sınıflandırıldı. CR ve PR ile hastalar yanıt olarak kabul edildi, diğerleri olmayan yanıt olarak sınıflandırıldı. İkincil sonuçlar tümör histolojisi, nüks boyutu ve eşzamanlı sistemik tedavi daya...

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.

Endobronşiyal Akciğer Kanseri İzole Mediastinal Nüks Tedavisinde Sisplatin intratümöral Enjeksiyon Ultrason eşliğinde

Isolated hilar and mediastinal recurrence (IMHR) following external beam radiation therapy (EBRT) in patients with lung cancer is common. These patients ...

endobronchial-ultrasound-guided-intratumoral-injection-cisplatin-for

Universidad de Cartagena UDEC

Research

JoVE Journal

Cancer Research

10.4K Görüntüleme.  University of Florida College of Medicine. 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. 

Video: Endobronchial Ultrasound-guided Intratumoral Injection of Cisplatin for the Treatment of Isolated Mediastinal Recurrence of Lung Cancer

Orthotopic Transplantation of Syngeneic Lung Adenocarcinoma Cells to Study PD-L1 Expression

The use of mouse models is indispensable for studying the pathophysiology of various diseases. With respect to lung cancer, several models are available, including genetically engineered models as well as transplantation models. However, genetically engineered mouse models are time-consuming and expensive, whereas some orthotopic transplantation models are difficult to reproduce. Here, a non-invasive intratracheal delivery method of lung tumor cells as an alternative orthotopic transplantation model is described. The use of mouse lung adenocarcinoma cells and syngeneic graft recipients allows studying tumorigenesis under the presence of a fully active immune system. Furthermore, genetic manipulations of tumor cells before transplantation makes this model an attractive time-saving approach to study the impact of genetic factors on tumor growth and tumor cell gene expression profiles under physiological conditions. Using this model, we show that lung adenocarcinoma cells express increased levels of the T-cell suppressor programmed death-ligand 1 (PD-L1) when grown in their natural environment as compared to cultivation in vitro.

Here we describe a minimally invasive syngeneic orthotopic transplantation model of mouse lung adenocarcinoma cells as a time- and cost-reducing model to study non-small cell lung cancer.

Orthotopic nakli PD-L1 ifade çalışmaya Syngeneic akciğer adenokarsinom hücre

The use of mouse models is indispensable for studying the pathophysiology of various diseases. With respect to lung cancer, several models are available, ...

Kanser Araştırmaları

Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions1. There is a wide variation in the published incidence rates due to the lack of a standardized definition for STG. Biopsy is often required to differentiate benign from malignant lesions. Unlike cervical thyroid, the overlying sternum precludes ultrasound-guided percutaneous fine needle aspiration of STG. Consequently, surgical mediastinoscopy is performed in the majority of cases, causing significant procedure related morbidity and cost to healthcare. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) is a frequently used procedure for diagnosis and staging of non-small cell lung cancer (NSCLC). Minimally invasive needle biopsy for lesions adjacent to the airways can be performed under real-time ultrasound guidance using EBUS. Its safety and efficacy is well established with over 90% sensitivity and specificity. The ability to perform EBUS as an outpatient procedure with same-day discharges offers distinct morbidity and financial advantages over surgery. As physicians performing EBUS gained procedural expertise, they have attempted to diversify its role in the diagnosis of non-lymph node thoracic pathologies. We propose here a role for EBUS-TBNA in the diagnosis of substernal thyroid lesions, along with a step-by-step protocol for the procedure.

Substernal thyroid lesions are common, and need to be differentiated from malignancy. Obtaining percutaneous fine needle biopsy is not possible due to its retrosternal location. This article proposes a protocol for biopsy of substernal thyroid lesions using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA).

Substernal Tiroid Biyopsi Endobronşiyal ultrason eşliğinde transbronşiyal Boßaltma kullanma

Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions1. There is a wide variation in the published incidence rates due to the ...

Tıp

Intubation-mediated Intratracheal (IMIT) Instillation: A Noninvasive, Lung-specific Delivery System

Respiratory disease studies typically involve the use of murine models as surrogate systems. However, there are significant physiologic differences between the murine and human respiratory systems, especially in their upper respiratory tracts (URT). In some models, these differences in the murine nasal cavity can have a significant impact on disease progression and presentation in the lower respiratory tract (LRT) when using intranasal instillation techniques, potentially limiting the usefulness of the mouse model to study these diseases. For these reasons, it would be advantageous to develop a technique to instill bacteria directly into the mouse lungs in order to study LRT disease in the absence of involvement of the URT. We have termed this lung specific delivery technique intubation-mediated intratracheal (IMIT) instillation. This noninvasive technique minimizes the potential for instillation into the bloodstream, which can occur during more invasive traditional surgical intratracheal infection approaches, and limits the possibility of incidental digestive tract delivery. IMIT is a two-step process in which mice are first intubated, with an intermediate step to ensure correct catheter placement into the trachea, followed by insertion of a blunt needle into the catheter to mediate direct delivery of bacteria into the lung. This approach facilitates a &#62;98% efficacy of delivery into the lungs with excellent distribution of reagent throughout the lung. Thus, IMIT represents a novel approach to study LRT disease and therapeutic delivery directly into the lung, improving upon the ability to use mice as surrogates to study human respiratory disease. Furthermore, the accuracy and reproducibility of this delivery system also makes it amenable to Good Laboratory Practice Standards (GLPS), as well as delivery of a wide range of reagents which require high efficiency delivery to the lung.

Intubation-mediated Intratracheal IMIT Instillation: A Noninvasive, Lung-specific Delivery System

Intubation-mediated intratracheal (IMIT) instillation of reagents is an excellent, noninvasive method for studying respiratory disease, as well as a method for instilling therapeutic reagents directly into the lung. It is a rapid and highly reproducible method which is suitable for preclinical testing.

Entübasyon-aracılı intratrakeal (IMIT) damlatma: A Noninvaziv, Lung-özel Dağıtım Sistemi

Respiratory disease studies typically involve the use of murine models as surrogate systems. However, there are significant physiologic differences ...

Ortotopik KHDAK Modellemek için Çok Hücreli Sferoidlerin İntrapulmoner Inokülasyonu

Construction of An Orthotopic Xenograft Model of Non-Small Cell Lung Cancer Mimicking Disease Progression and Predicting Drug Activities

Non-small cell lung cancer (NSCLC) is a highly lethal disease with a complex and heterogeneous tumor microenvironment. Currently, common animal models based on subcutaneous inoculation of cancer cell suspensions do not recapitulate the tumor microenvironment in NSCLC. Herein we describe a murine orthotopic lung cancer xenograft model that employs the intrapulmonary inoculation of three-dimensional multicellular spheroids (MCS). Specifically, fluorescent human NSCLC cells (A549-iRFP) were cultured in low-attachment 96-well microplates with collagen for 3 weeks to form MCS, which were then inoculated intercostally into the left lung of athymic nude mice to establish the orthotopic lung cancer model.
Compared with the original A549 cell line, MCS of the A549-iRFP cell line responded similarly to anticancer drugs. The long-wavelength fluorescent signal of the A549-iRFP cells correlated strongly with common markers of cancer cell growth, including spheroid volume, cell viability, and cellular protein level, thus allowing dynamic monitoring of the cancer growth in vivo by fluorescent imaging. After inoculation into mice, the A549-iRFP MCS xenograft reliably progressed through phases closely resembling the clinical stages of NSCLC, including the expansion of the primary tumor, the emergence of neighboring secondary tumors, and the metastases of cancer cells to the contralateral right lung and remote organs. Moreover, the model responded to the benchmark antilung cancer drug, cisplatin with the anticipated toxicity and slower cancer progression. Therefore, this murine orthotopic xenograft model of NSCLC would serve as a platform to recapitulate the disease&#39;s progression and facilitate the development of potential anticancer drugs.

Yazar Gündemi: Antikanser İlaçlarının Nanoformülasyonlarını Geliştirmek için Murin Küçük Hücreli Dışı Akciğer Kanseri Modelinin Oluşturulması

This study presents an orthotopic non-small cell lung cancer (NSCLC) model based on intrapulmonary inoculation of multicellular spheroids of fluorescent A549-iRFP cells. The model recapitulates clinical NSCLC stages and responds to cisplatin, according to dynamic in vivo monitoring of long-wavelength fluorescence.

Küçük Hücreli Dışı Akciğer Kanserinde Hastalık Progresyonunu Taklit Eden ve İlaç Aktivitelerini Tahmin Eden Ortotopik Ksenogreft Modelinin Oluşturulması

Non-small cell lung cancer (NSCLC) is a highly lethal disease with a complex and heterogeneous tumor microenvironment. Currently, common animal models ...

Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy

Physicians considering stereotactic ablative body radiation therapy (SBRT) for the treatment of extracranial cancer targets must be aware of the sizeable risks for normal tissue injury and the hazards of physical tumor miss. A first-of-its-kind SBRT platform achieves high-precision ablative radiation treatment through a combination of versatile real-time imaging solutions and sophisticated tumor tracking capabilities. It uses dual-diagnostic kV x-ray units for stereoscopic open-loop feedback of cancer target intrafraction movement occurring as a consequence of respiratory motions and heartbeat. Image-guided feedback drives a gimbaled radiation accelerator (maximum 15 x 15 cm field size) capable of real-time &#177;4 cm pan-and-tilt action. Robot-driven &#177;60&#176; pivots of an integrated &#177;185&#176; rotational gantry allow for coplanar and non-coplanar accelerator beam set-up angles, ultimately permitting unique treatment degrees of freedom. State-of-the-art software aids real-time six dimensional positioning, ensuring irradiation of cancer targets with sub-millimeter accuracy (0.4 mm at isocenter). Use of these features enables treating physicians to steer radiation dose to cancer tumor targets while simultaneously reducing radiation dose to normal tissues. By adding respiration correlated computed tomography (CT) and 2-[18F] fluoro-2-deoxy-&#7429;-glucose (18F-FDG) positron emission tomography (PET) images into the planning system for enhanced tumor target contouring, the likelihood of physical tumor miss becomes substantially less1. In this article, we describe new radiation plans for the treatment of moving lung tumors.

Stereotactic ablative body radiation therapy (SBRT) involves the precise delivery of high-dose radiation to cancer tumor targets. A novel SBRT platform offers a first-of-its-kind gimbaled radiation accelerator mounted within a pivoting O-ring gantry capable of dynamic image-guided tumor tracking. Here, we describe dynamic tumor tracking for lung targets.

Stereotaktik Ablatif Vücut Radyasyon Tedavisi için Dinamik Akciğer Tümör Takibi

Physicians considering stereotactic ablative body radiation therapy (SBRT) for the treatment of extracranial cancer targets must be aware of the sizeable ...

Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy

The prognosis of patients with metastatic cancers has improved in the past decades due to effective chemotherapy and oligometastatic surgery. For inoperable patients, local ablation therapies, such as stereotactic body radiotherapy (SBRT), can provide effective local tumor control with minimal toxicity. Because of its high precision and accuracy, SBRT delivers a higher radiation dose per fraction, is more effective, and targets smaller irradiation volumes than does conventional radiotherapy. In addition, steep dose gradients from target lesions to surrounding normal tissues are achieved using SBRT; thus, SBRT provides more effective tumor control and exhibits fewer side effects than conventional radiotherapy. The use of SBRT is prevalent for treating intracranial lesions (known as stereotactic radiosurgery); however, it is now also used for treating spinal and adrenal metastases. Because of advancements in image-guided assistance and respiratory motion management, several studies have investigated the use of SBRT for treating lung or liver tumors, which move as a patient breathes. The results of these studies have suggested that SBRT favorably controls tumors in the case of moving lesions.
Four-dimensional computed tomography (4D-CT) with an abdominal compressor (AC) is clinically convenient for effective respiratory motion management. Because this method is noninvasive and allows free breathing, its use reduces complications. Furthermore, patients consider this method convenient. Moreover, it is considered more efficient than other methods of respiratory motion management by physicians and therapists. The use of 4D-CT with an AC for treating pulmonary lesions has also been widely investigated, and the technique is gaining acceptance for treating hepatic lesions. However, the protocols for using 4D-CT with an AC for treating hepatic lesions are different from those used for treating pulmonary lesions. In this article, we describe a new protocol for SBRT with 4D-CT and an AC for treating liver metastases.

Stereotactic body radiotherapy (SBRT) requires rigorous accuracy and precision for delivering high radiation doses per fraction to small treatment volumes to improve tumor control and simultaneously reduce toxicity. Herein, we present a noninvasive and clinically convenient respiratory motion management protocol for SBRT for liver metastases.

Stereotaksik vücut radyoterapi için bir iç hedef birim yöntemini kullanarak karaciğer metastaz tedavisi

The prognosis of patients with metastatic cancers has improved in the past decades due to effective chemotherapy and oligometastatic surgery. For ...

Direct Intrabronchial Administration to Improve the Selective Agent Deposition Within the Mouse Lung

Intratracheal (IT) administration of experimental agents is an essential technique in murine models of diffuse lung diseases, such as bleomycin-induced pulmonary fibrosis.&#160; However, distribution of intratracheally-administered agents to the distal mouse lung is often asymmetric, with lung parenchymal concentrations increased in the smaller (but equally accessible) left lung of the mouse.&#160; Described in this report is a novel intrabronchial (IB) approach to cannulate the left and/or right lungs of living mice non-operatively.&#160; It is also demonstrated how this approach can be used to selectively administer agents to one lung or adapted (via dose-adjusted IB delivery) to improve the left-right symmetry of lung delivery of experimental agents, thereby improving models of diffuse lung disease such as bleomycin-induced pulmonary fibrosis.

Intratracheal (IT) administration of experimental agents in mice often results in asymmetric delivery to the distal lungs.&#160; In this report, we describe a direct intrabronchial (IB) approach to cannulate each lung in living mice non-operatively.&#160; This approach can be used to selectively administer agents to one lung or may be adapted to improve the symmetric agent delivery to both lungs.

Fare akciğer Içinde seçici Ajan biriktirme geliştirmek için doğrudan Intrabronchial yönetim

Intratracheal (IT) administration of experimental agents is an essential technique in murine models of diffuse lung diseases, such as bleomycin-induced ...

A Stepwise Approach for Performing Ultrasound Guided Transthoracic Lung Biopsy

Diagnosing patients with radiological lung lesions, especially those suspected of having primary lung cancer, is a common and critical clinical scenario. When selecting the most suitable invasive procedure to establish a diagnosis in these cases, a delicate balance must be struck between achieving a high diagnostic yield, providing staging information, minimizing potential complications, enhancing the patient experience, and controlling costs. The integration of thoracic ultrasound as a routine clinical tool in respiratory medicine has led to increased awareness and utilization of ultrasound-guided invasive techniques in chest procedures, including transthoracic biopsies. By following a systematic and stepwise approach, transthoracic ultrasound-guided lung biopsy emerges as a safe, cost-effective procedure with a remarkable diagnostic accuracy. These attributes collectively position it as an ideal invasive technique when technically feasible. Consequently, in patients presenting subpleural lung lesions suspected of malignancy, transthoracic ultrasound-guided lung biopsy has become a standard procedure in the realm of modern invasive pulmonology.

<meta charset="utf8"></head><body>Ultrason Eşliğinde Transtorasik Akciğer Biyopsisi Yapmak için Aşamalı Bir Yaklaşım

Transthoracic ultrasound-guided lung biopsy represents a safe, cost-effective, and efficient approach for patients presenting with subpleural lung lesions suspected of malignancy. Employing a systematic, step-by-step process is crucial to achieve optimal patient selection, minimize complication risks, and maximize diagnostic accuracy.

Ultrason Eşliğinde Transtorasik Akciğer Biyopsisi Yapmak için Aşamalı Bir Yaklaşım

Diagnosing patients with radiological lung lesions, especially those suspected of having primary lung cancer, is a common and critical clinical scenario. ...

Endobronşiyal Akciğer Kanseri İzole Mediastinal Nüks Tedavisinde Sisplatin intratümöral Enjeksiyon Ultrason eşliğinde

Özet

Daha Fazla Video Keşfet

Bu videodaki bölümler

Orthotopic nakli PD-L1 ifade çalışmaya Syngeneic akciğer adenokarsinom hücre

Substernal Tiroid Biyopsi Endobronşiyal ultrason eşliğinde transbronşiyal Boßaltma kullanma

Entübasyon-aracılı intratrakeal (IMIT) damlatma: A Noninvaziv, Lung-özel Dağıtım Sistemi

Küçük Hücreli Dışı Akciğer Kanserinde Hastalık Progresyonunu Taklit Eden ve İlaç Aktivitelerini Tahmin Eden Ortotopik Ksenogreft Modelinin Oluşturulması

Küçük Hücreli Dışı Akciğer Kanserinde Hastalık Progresyonunu Taklit Eden ve İlaç Aktivitelerini Tahmin Eden Ortotopik Ksenogreft Modelinin Oluşturulması

Küçük Hücreli Dışı Akciğer Kanserinde Hastalık Progresyonunu Taklit Eden ve İlaç Aktivitelerini Tahmin Eden Ortotopik Ksenogreft Modelinin Oluşturulması

Stereotaktik Ablatif Vücut Radyasyon Tedavisi için Dinamik Akciğer Tümör Takibi

Stereotaksik vücut radyoterapi için bir iç hedef birim yöntemini kullanarak karaciğer metastaz tedavisi

Fare akciğer Içinde seçici Ajan biriktirme geliştirmek için doğrudan Intrabronchial yönetim

Ultrason Eşliğinde Transtorasik Akciğer Biyopsisi Yapmak için Aşamalı Bir Yaklaşım