超声引导下的瘤内直接注射疗法:技术和后勤考虑因素综述。

IF 3.5 2区 医学 Q2 ONCOLOGY
George Gabriel Bitar, Melissa Persad, Alina Dragan, Adebayo Alade, Pablo Jiménez-Labaig, Edward Johnston, Samuel J Withey, Nicos Fotiadis, Kevin J Harrington, Derfel Ap Dafydd
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引用次数: 0

摘要

背景:直接注射疗法(DIT)包括癌症免疫疗法研究领域中的多种药物,在各种肿瘤亚型中的临床试验结果令人鼓舞。目前,大多数此类疗法只能在临床试验中使用;不过,最近,talimogene laherparepvec(T-VEC,Imlygic)作为第一种溶瘤病毒疗法在美国和欧洲获得批准。我院参与了多项不同的 DIT 疗效试验,其中大部分试验都是由肿瘤专家在临床上进行的。然而,一些特殊的、具有挑战性的病例--主要是颈部肿瘤--需要在图像引导下进行治疗:这篇综述文章探讨了将图像引导 DIT 纳入现有超声服务的相关技术和后勤因素。对于某些无法触诊或位于高风险位置(如邻近血管)的目标,经常需要图像引导(通常使用超声波)。为了提供安全、高效的服务,必须采用多学科方法,包括谨慎选择病例。在将此类服务纳入既定的超声实践时,需要遵循某些协议和指南,以提高效率并优化安全性。本文从文献和我们在一家三级癌症中心的早期经验中总结出学习要点,即在图像引导下对 22 名患者(包括 11 名颈部肿块患者)进行 DIT,涉及试验方案、术前检查、组织、计划、同意、技术方面、手术耐受性、技术成功率和术后注意事项:结论:通过适当的计划和协调,并应用本文讨论的学习要点,可以安全、高效地将图像引导下的 DIT 管理纳入既定的超声程序清单中。这对癌症中心、放射科、放射科医生和其他团队成员都有意义,因为他们在满足新出现的对这些手术的需求方面扮演着重要角色。本文就开发此类成像服务提出了建议,并对不久的将来放射科医生在癌症治疗中不断发展的职责提供了一定的见解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ultrasound-guided intra-tumoral administration of directly-injected therapies: a review of the technical and logistical considerations.

Background: Directly-injected therapies (DIT) include a broad range of agents within a developing research field in cancer immunotherapy, with encouraging clinical trial results in various tumour subtypes. Currently, the majority of such therapies are only available within clinical trials; however, more recently, talimogene laherparepvec (T-VEC, Imlygic) has been approved as the first oncolytic virus therapy in the USA and Europe. Our institution contributes to multiple different trials exploring the efficacy of DIT, the majority of which are performed by oncologists in clinic. However, specific, challenging cases - mainly neck tumours - require image-guided administration.

Main body: This review article addresses the technical and logistical factors relevant to the incorporation of image-guided DIT into an established ultrasound service. Image-guidance (usually with ultrasound) is frequently needed for certain targets that cannot be palpated or are in high-risk locations, e.g. adjacent to blood vessels. A multi-disciplinary approach is essential to facilitate a safe and efficient service, including careful case-selection. Certain protocols and guidance need to be followed when incorporating such a service into an established ultrasound practice to enhance efficiency and optimise safety. Key learning points are drawn from the literature and from our early experience at a tertiary cancer centre following image guided DIT for an initial cohort of 22 patients (including 11 with a neck mass), addressing trial protocols, pre-procedure work-up, organisation, planning, consent, technical aspects, procedure tolerability, technical success, and post-procedure considerations.

Conclusion: With appropriate planning and coordination, and application of the learning points discussed herein, image-guided administration of DIT can be safely and efficiently incorporated into an established procedural ultrasound list. This has relevance to cancer centres, radiology departments, individual radiologists, and other team members with a future role in meeting the emerging need for these procedures. This paper provides advice on developing such an imaging service, and offers certain insights into the evolving remit of radiologists within cancer care in the near future.

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来源期刊
Cancer Imaging
Cancer Imaging ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
CiteScore
7.00
自引率
0.00%
发文量
66
审稿时长
>12 weeks
期刊介绍: Cancer Imaging is an open access, peer-reviewed journal publishing original articles, reviews and editorials written by expert international radiologists working in oncology. The journal encompasses CT, MR, PET, ultrasound, radionuclide and multimodal imaging in all kinds of malignant tumours, plus new developments, techniques and innovations. Topics of interest include: Breast Imaging Chest Complications of treatment Ear, Nose & Throat Gastrointestinal Hepatobiliary & Pancreatic Imaging biomarkers Interventional Lymphoma Measurement of tumour response Molecular functional imaging Musculoskeletal Neuro oncology Nuclear Medicine Paediatric.
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