Percutaneous Image-Guided Ablation of Lung Tumors

Tumors of the lung, including primary cancer and metastases, are notoriously common and difficult to treat. Although surgical resection of lung lesions is often indicated, many conditions disqualify patients from being surgical candidates. Percutaneous image-guided lung ablation is a relatively new set of techniques that offers a promising treatment option for a variety of lung tumors. Although there have been no clinical trials to definitively compare its efficacy to those of traditional treatments, lung ablation is widely practiced and generally accepted to be safe and effective. Especially encouraging results have recently emerged for cryoablation, one of the newer ablative techniques. This article reviews the indications, techniques, contraindications, and complications of percutaneous image-guided ablation of lung tumors with special attention to cryoablation and its recent developments in protocol optimization.

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397 Intra-tumor immunotherapy injections utilizing image guidance in interventional radiology: clinical trial experience at a tertiary care cancer center

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-sitc2020.0397 ◽

2020 ◽

Vol 8 (Suppl 3) ◽

pp. A422-A422

Author(s):

Ravi Murthy ◽

Rahul Sheth ◽

Alda Tam ◽

Sanjay Gupta ◽

Vivek Subbiah ◽

...

Keyword(s):

Clinical Trials ◽

Interventional Radiology ◽

Real Time ◽

Image Guidance ◽

Tertiary Care ◽

Cancer Center ◽

Imaging Guidance ◽

Image Guided ◽

Real Time Image ◽

Time Image

BackgroundImage guided intra-tumor administration of investigational immunotherapeutic agents represents an expanding field of interest. We present a retrospective review of the safety, feasibility & technical nuances of real-time image guidance for injection & biopsy across a spectrum of extracranial solid malignancies utilizing the discipline of Interventional Radiology.MethodsPatients who were enrolled in image guided intratumoral immunotherapy injection (ITITI) clinical trials over a 6 year period (2013–19) at a single tertiary care cancer center were included in this analysis. Malignancy, location, imaging guidance utilized for ITITI & biopsy for injected (adscopal) & non-injected (abscopal) lesions were determined and categorized. Peri-procedural adverse events were noted.Results262 pts (146 female, 61 yrs median) participating in 29 immunotherapeutic clinical trials (TLR & STING agonists, gene therapy, anti CD-40, viral/bacterial/metabolic oncolytics) met study criteria. Malignancies included melanoma 88, sarcoma 32, colorectal 29, breast 23, lung 17, head & neck 15, ovarian 8, neuroendocrine 7, pancreatic adenocarcinoma 6, 3 each (cholangioCA, endometrial, bladder, GI tract), 2 each (RCC, thymicCA, lymphoma, merkel cell, prostate) & others 1 each (CUP, GIST, dermatofibrosarcoma, DSRT, neuroblastoma, thyroid). All 169 & 93 patients received the intended 1371 ITITI in parietal (abdominal/chest wall, extremity, neck, pelvis) or visceral (liver, lung, peritoneum, adrenal) locations respectively; 83 patients received lymph node injections within either location. Imaging guidance was US in 68% of the cohort (US 161, CT+US 19); CT was used in 30% (81) & MRI in 1 patient. Median diameter of the ITITI lesion was 32 mm (8–230 mm). Median volume of the ITITI therapeutic material/session was 2 ml (1–6.9 ml). Lesions were accessed using a coaxial technique. ITITI delivery needles used at operator preference & tailored to lesion characteristics were either a 21G/22G Chiba, 21G Profusion (Cook Medical), 22G Morrison (AprioMed), 25G hypodermic (BD) & 18G Quadrafuse (Rex Medical). 2840 core biopsies (>18G Tru-cut core, Mission, Bard Medical) were performed in 237 patients during 690 procedures; biopsy sessions were often concurrent & of the ITITI site. 137 patients also underwent biopsy of a non-ITITI site (89 parietal location). Dimensions of the non-ITITI lesion were median 10 mm (7–113 mm); US image guidance was used in 97 patients (72%) to obtain a total of 1257, >18G Tru-core samples. 1.3% of injections resulted in SAE (NCI CTC AE >3) and 0.5% of 4097 biopsies developed major complications (SIR Criteria); both categories were manageable.ConclusionsUtilizing real time image guidance, ITITI to the administration of a myriad of investigational immunotherapeutic agents with concomitant biopsy procedures to date are associated with a high technical success rate & favorable safety profile.AcknowledgementsJoshua Hein, Mara Castaneda, Jyotsna Pera, Yunfang Jiang,Shuang Liu, Holly Liu and Anna LuiTrial RegistrationN/AEthics ApprovalThe study was approved by Institution’s Ethics Board, approval number 2020-0536: A retrospective study to determine the safety, feasibility and technical challenges of real-time image guidance for intra-tumor injection and biopsy across multiple solid tumors.Consent2020-0536 Waiver of Informed ConsentReferenceSheth RA, Murthy R, Hong DS, et al. Assessment of image-guided intratumoral delivery of immunotherapeutics in patients with cancer. JAMA Netw Open 2020;3(7):e207911. doi:10.1001/jamanetworkopen.2020.7911

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Recurrent Chordoma Resection in the Advanced Multimodality Image Guided Operating Suite: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa445 ◽

2021 ◽

Vol 20 (5) ◽

pp. E344-E345

Author(s):

Walid Ibn Essayed ◽

Kaith K Almefty ◽

Ossama Al-Mefty

Keyword(s):

Skull Base ◽

Surgical Resection ◽

Petrous Apex ◽

Tumor Control ◽

Image Guided ◽

Endoscopy Ultrasound ◽

Radiation Induced ◽

Multimodality Image ◽

The Right ◽

Operating Suite

Abstract Recurrent skull base chordomas are challenging lesions. They already had maximum radiation, and in the absence of any effective medical treatment, surgical resection is the only treatment.1,2 Surgery on recurrent previously radiated chordomas, however, carries much higher risk and the likelihood of subtotal resection. Maximizing tumor resection allows longer tumor control.3-5 The Advanced Multimodality Image Guided Operating Suite developed at the Brigham and Women's Hospital, Harvard Medical School, with the support of the National Institutes of Health, provides an optimal environment to manage these tumors. It offers the capability to obtain and integrate multiple modalities during surgery, including magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT), endoscopy, ultrasound, fluoroscopy, and the ability to perform emergent endovascular procedures.5-7 The patient is a 39-yr-old male, presenting after 19 yr follow-up of a surgical resection and proton beam treatment for a skull base chordoma. He developed progressive ophthalmoplegia due to recurrence of his chordoma at the right petrous apex and cavernous sinus. Preoperative angiography demonstrated narrowing of the petrous segment of the right carotid artery suspect of radiation-induced angiopathy. The presence of radiation-induced angiopathy increases the risk of intraoperative carotid rupture, and the availability of endovascular intervention in the operative suite added favorable preparedness to deal with such complications if they happen. Given the clinical and radiological progression, surgical intervention was carried out through the prior zygomatic approach with the goal of performing maximum resection.8 The patient had an uneventful postoperative course and remained stable until he had a second recurrence 4 yr later. The patient consented to the procedure.

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Effects of open-label placebos in clinical trials: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-83148-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Melina von Wernsdorff ◽

Martin Loef ◽

Brunna Tuschen-Caffier ◽

Stefan Schmidt

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Medical Condition ◽

Data Extraction ◽

Meta Analysis ◽

Risk Of Bias ◽

Open Label ◽

Cancer Related Fatigue ◽

Promising Treatment ◽

Irritable Bowel

AbstractOpen-label placebos (OLPs) are placebos without deception in the sense that patients know that they are receiving a placebo. The objective of our study is to systematically review and analyze the effect of OLPs in comparison to no treatment in clinical trials. A systematic literature search was carried out in February 2020. Randomized controlled trials of any medical condition or mental disorder comparing OLPs to no treatment were included. Data extraction and risk of bias rating were independently assessed. 1246 records were screened and thirteen studies were included into the systematic review. Eleven trials were eligible for meta-analysis. These trials assessed effects of OLPs on back pain, cancer-related fatigue, attention deficit hyperactivity disorder, allergic rhinitis, major depression, irritable bowel syndrome and menopausal hot flushes. Risk of bias was moderate among all studies. We found a significant overall effect (standardized mean difference = 0.72, 95% Cl 0.39–1.05, p < 0.0001, I2 = 76%) of OLP. Thus, OLPs appear to be a promising treatment in different conditions but the respective research is in its infancy. More research is needed, especially with respect to different medical and mental disorders and instructions accompanying the OLP administration as well as the role of expectations and mindsets.

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Co-Clinical Trials: An Innovative Drug Development Platform for Cholangiocarcinoma

Pharmaceuticals ◽

10.3390/ph14010051 ◽

2021 ◽

Vol 14 (1) ◽

pp. 51

Author(s):

Brinda Balasubramanian ◽

Simran Venkatraman ◽

Kyaw Zwar Myint ◽

Tavan Janvilisri ◽

Kanokpan Wongprasert ◽

...

Keyword(s):

Clinical Trials ◽

Targeted Therapy ◽

Drug Development ◽

Surgical Resection ◽

Treatment Options ◽

Standard Of Care ◽

Time Data ◽

Current Standard ◽

Innovative Drug ◽

Curative Intent

Cholangiocarcinoma (CCA), a group of malignancies that originate from the biliary tract, is associated with a high mortality rate and a concerning increase in worldwide incidence. In Thailand, where the incidence of CCA is the highest, the socioeconomic burden is severe. Yet, treatment options are limited, with surgical resection being the only form of treatment with curative intent. The current standard-of-care remains adjuvant and palliative chemotherapy which is ineffective in most patients. The overall survival rate is dismal, even after surgical resection and the tumor heterogeneity further complicates treatment. Together, this makes CCA a significant burden in Southeast Asia. For effective management of CCA, treatment must be tailored to each patient, individually, for which an assortment of targeted therapies must be available. Despite the increasing numbers of clinical studies in CCA, targeted therapy drugs rarely get approved for clinical use. In this review, we discuss the shortcomings of the conventional clinical trial process and propose the implementation of a novel concept, co-clinical trials to expedite drug development for CCA patients. In co-clinical trials, the preclinical studies and clinical trials are conducted simultaneously, thus enabling real-time data integration to accurately stratify and customize treatment for patients, individually. Hence, co-clinical trials are expected to improve the outcomes of clinical trials and consequently, encourage the approval of targeted therapy drugs. The increased availability of targeted therapy drugs for treatment is expected to facilitate the application of precision medicine in CCA.

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Image-Guided Intratumoral Delivery of Immunotherapeutics in Gastrointestinal Malignancies

Digestive Disease Interventions ◽

10.1055/s-0040-1718389 ◽

2021 ◽

Author(s):

Yang Qiao ◽

Rahul A. Sheth ◽

Alda Tam

Keyword(s):

Viral Vectors ◽

Adaptive Immune System ◽

Clinical Development ◽

Gastrointestinal Malignancies ◽

Robust Immune Response ◽

Image Guided ◽

Current State ◽

Specific Antigens ◽

Promising Treatment ◽

Intratumoral Delivery

AbstractIntratumoral (IT) administration of immunotherapy is a promising treatment strategy under clinical development for gastrointestinal malignancies. Due to its targeted nature, IT immunotherapies can generate regional proinflammatory microenvironments that result in the focal recruitment of tumor-specific immune cells. Precision targeting of tumors via IT immunotherapy injection theoretically produces a more robust immune response to the treated tumor itself and to distant metastatic tumors that share tumor-specific antigens with those of the treated tumor, while also minimizing the priming of the adaptive immune system to nonspecific antigens. Diverse arrays of IT immunotherapeutic agents including but not limited to lyophilized bacteria, viral vectors, cellular-based agents, molecules, and peptides, both as monotherapies and in combination with systemic immunotherapies, are in various stages of preclinical and clinical development. In this review, we summarize the current state of the art for IT immunotherapy and highlight potential future directions and their relevance to image-guided interventionalists.

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Influence of different image-guided tracking methods upon the local efficacy of CyberKnife treatment in lung tumors

Thoracic Cancer ◽

10.1111/1759-7714.12174 ◽

2015 ◽

Vol 6 (3) ◽

pp. 255-259 ◽

Cited By ~ 9

Author(s):

Yihang Guo ◽

Hongqing Zhuang ◽

Lujun Zhao ◽

Zhiyong Yuan ◽

Ping Wang

Keyword(s):

Lung Tumors ◽

Image Guided

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Technology Insight: image-guided therapies for hepatocellular carcinoma—intra-arterial and ablative techniques

Nature Clinical Practice Oncology ◽

10.1038/ncponc0512 ◽

2006 ◽

Vol 3 (6) ◽

pp. 315-324 ◽

Cited By ~ 41

Author(s):

Kelvin Hong ◽

Christos S Georgiades ◽

Jean-Francois H Geschwind

Keyword(s):

Hepatocellular Carcinoma ◽

Image Guided ◽

Ablative Techniques

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The role of percutaneous image-guided ablation for lung tumors

La radiologia medica ◽

10.1007/s11547-014-0427-7 ◽

2014 ◽

Vol 119 (7) ◽

pp. 541-548 ◽

Cited By ~ 5

Author(s):

Elena N. Petre ◽

Stephen B. Solomon ◽

Constantinos T. Sofocleous

Keyword(s):

Lung Tumors ◽

Image Guided

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Patient With Unresectable Cholangiocarcinoma Treated With Radiofrequency Hyperthermia in Combination With Chemotherapy: A Case Report

Integrative Cancer Therapies ◽

10.1177/1534735417722225 ◽

2017 ◽

Vol 17 (2) ◽

pp. 558-561 ◽

Cited By ~ 2

Author(s):

Juyoung Ryu ◽

Kangwook Lee ◽

Changmug Joe ◽

JongCheon Joo ◽

Namhun Lee ◽

...

Keyword(s):

Case Report ◽

Treatment Option ◽

Carbohydrate Antigen ◽

Klatskin Tumor ◽

Preoperative Radiation ◽

Noninvasive Treatment ◽

Patients With Cancer ◽

Radiofrequency Hyperthermia ◽

Promising Treatment ◽

Tomography Scan

Hyperthermia, which is a noninvasive treatment that causes tumor cells to become heated and that works in synergy with anticancer drugs and radiation therapy, is emerging as a promising treatment for patients with cancer. The purpose of this study is to report the efficacy of hyperthermia combined with chemotherapy (gemcitabine/cisplatin) for the treatment of a patient with unresectable cholangiocarcinoma. A 54-year-old man was diagnosed as hilar cholangiocarcinoma (Klatskin tumor) and was administered neoadjuvant and preoperative radiation with chemotherapy. However, because the treatment with radiation and chemotherapy was not successful, he decided to undergo hyperthermia combined with chemotherapy as a second treatment option. He was suffering from fatigue, dyspepsia, epigastralgia, and jaundice. Hyperthermia combined with chemotherapy was administered 32 times over a period of 4 months. The patient experienced no critical complications, and the patient’s condition improved, with the carbohydrate antigen 19-9 (CA 19-9) and the total bilirubin levels being relatively lowered. In addition, the computed tomography scan showed that the cholangiocarcinoma had not progressed. In conclusion, this case report suggests radiofrequency hyperthermia combined with chemotherapy may be a promising treatment option for patients with unresectable cholangiocarcinoma.

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