이 연구는 타이베이 의과대학 병원 (106TMUH-NE-02)에 의해 지원 되었다.

타이페이 의학 대학 공동 기관 검토 위원회 승인이이 연구에 대 한 얻은 했다.
1. SBRT 상담
<ol><li>여러 종양 보드 여 간 전이의 처리를 위한 SBRT에 대 한 환자 자격 평가. 참고: 로컬 제거 뿐만 아니라 작업에 대 한 필요성 및 다른 치료 옵션 종양 위원회에 의해 평가 되어야 합니다. 우리의 선택 기준 다음과 같이 했다: 좋은 성능 상태 (동부 협동 종양학 그룹 0-1), 2) 제어 1) 성인 환자 암 상태, 3) 간 장애의 수에에서만 oligometastases와 항 암 약물 치료를 통해 ≤3 및 큰 종양 ≤6 cm 직경, 4) 간 볼륨 (간 총 종양 제외) 700 cm3및 5 보다 큰) 급성 간염 또는 만성 B 형 간염 안정 항 바이러스 통제 없이.</li>
	<li>SBRT와 기존의 방사선 치료 환자9,19의 차이 뿐만 아니라 SBRT와 관련 된 위험을 설명 합니다.</li>
</ol>2. CT 시뮬레이션
<ol><li>
부정사 위치, 머리 위로 팔을 소파에 머리 처음에에서 환자를 배치 합니다.
	<ol>
<li>환자를 고정 하는 시스템 (예, BodyFIX)를 사용 합니다. 맞춤, 대피 진공 가방에 환자를 놓고 표지를 환자를 커버 합니다.</li>
		<li>복 부 압축기 (AC)를 적용 하 고 AC의 깊이 표시. 참고: AC 제한 환자의 호흡 모션; 따라서, 일부 환자는이 절차 동안 호흡을 개발할 수 있습니다. 비 강 캐 뉼 러를 통해 산소 보충은 그들의 불편을 해소 하기 위해 제공 되어야 한다.</li>
		<li>가슴 벽에 숨 결 추적 센서를 놓고 호흡 파형 모니터링 합니다.</li>
	</ol>
</li>
	<li>
방사선 치료 계획 CT 이미지를 취득 합니다.
	<ol>
<li>3mm 슬라이스 두께 4 D CT 스캔 모드를 선택 합니다.</li>
		<li>Surview 검사를 실시 (120 kV, 30 mA) 앞쪽 후부 (AP) 및 환자의 측면 보기. "Go에 클릭" 화면에 컨트롤 패널.</li>
		<li>"헬리컬 스캔" 페이지 매김 아래 CT 스캐닝 범위를 결정 하 고 "폐 게이팅 검색" 페이지 매김 아래 4 D CT의 검색 필드를 결정 합니다. 참고: 헬리컬 스캔의 범위 간의 꼬리 테두리에서 적어도 5 cm의 거리를 두는 폐의 정점에서 연장 해야 합니다. 헬리컬 스캔 보다 작습니다, 폐 제어 스캔 분야 커버 3-5 cm로 간 간 두개골과 꼬리 테두리에서 연장 해야 합니다.</li>
		<li>그것은 3 분 동안 안정적으로 유지 될 때까지 호흡 파형을 모니터링 합니다.</li>
		<li>(예, Omnipaque), 4-5 mL의 속도로 대비 에이전트의 100 mL 주입/s antecubital로 18 G i.v. 카 테 터를 통해 정 맥.</li>
		<li>대조 연속 된 나선형 CT 검사를 실시 (120 kV, 400 매스/슬라이스), 15 대조 주입 후 s.</li>
		<li>그 후 비 대조 4 D-CT 검사를 실시 (120 kV, 2000 매스/슬라이스) 시리즈 "다음"을 클릭 하 여.</li>
	</ol>
</li>
</ol>3. 방사선 치료 계획
<ol><li>
계획 시스템으로 CT 시뮬레이션 및 진단 검사에서 이미지를 가져옵니다. 참고: 진단 이미지는 양전자 방출 단층 촬영 (PET)를 포함할 수 있습니다 / 애완 동물 CT, 자기 공명 이미지, 또는 진단 나선형 CT 검사.</li>
	<li>
총 종양 볼륨 및 위험 (노)에 인접 한 기관으로 컨투어 전이성 종양.
	<ol>
<li>기관 (여기, 복 부)를 선택 하 고 브러시, 연필, 등을 사용 하 여. CT 이미지의 각 조각에 기관 컨투어 하. 동그라미 하거나 관심의 기관. 각 이미지 슬라이스를 "위로" 및 "아래로" 단추를 사용 합니다. 참고: 노가 포함 폐, 위, 십이지 장, 척수, 간, 작은 창, 갈비, 그리고 신장.</li>
	</ol>
</li>
	<li>
동적 추적 이미지에 관찰 기관 움직임에 따라 종양의 내부 대상 볼륨 (ITV) 컨투어. 계획 대상 볼륨 (PTV)를 얻기 위해 ITV에 5 m m 마진을 추가 합니다.
	<ol>
<li>기관 (여기, 복 부)를 선택 하 고 브러시, 연필, 등을 사용 하 여. CT 이미지의 각 조각에 기관 컨투어 하. 동그라미 하거나 관심의 기관. 각 이미지 슬라이스를 "위로" 및 "아래로" 단추를 사용 합니다.</li>
	</ol>
</li>
	<li>3 분수에 48 Gy 또는 비교적 큰 종양에 대 한 PTV 5 분수에 35 Gy의 방사선 복용량을 처방. 참고: 치료 계획 때문에 노; 제약을 고려해 야 노에 방사선 복용량은 (표 1) 제약 조건 내에서 상대적으로 높은 처방 복용량 허용 될 수 있습니다.</li>
</ol>4. 치료 배달
<ol><li>일일 품질 보증을 사용 하 여 방사선 빔을 데이터를 재확인 하 고 데이터 정상 범위 내에 있는지 확인 합니다.</li>
	<li>환자의 이름, 생년월일, 및 ID 카드를 사용 하 여 환자를 식별 합니다. 진공 가방, 장소, 표지 및 CT 시뮬레이션 섹션에 설명 된 절차에 따라 수정 AC 위치 환자입니다.</li>
	<li>
4 D 콘 빔 CT (CBCT) 이미지를 획득 하 고 소파 상관 4 D CBCT 이미지를 얻은 시뮬레이션 CT 이미지에는 대상 위치를 조정 합니다.
	<ol>
<li>4 D CBCT 모드를 선택 하 고 설정 데이터를 확인 합니다. 패널에서 "이동"을 클릭 합니다.</li>
	</ol>
</li>
	<li>
4 D CBCT, 후 IGRT 시스템에 인수 4 차원 CBCT 이미지를 로드 합니다. 그리고 상단 왼쪽 컨투어링 및 치료 계획 CT 시뮬레이션에서 낮은 오른쪽 이미지는. 바로 낮은 이미지 왼쪽 상단 4 D CBCT, 각 분수 전에 매일 수행에서 있습니다.
	<ol>
<li>소프트웨어를 사용 하 여 집합을 조정 하려면. 그런 다음, 수동으로 소파에 각 매개 변수 조정. 소파는 3 선형 동작에서 X, Y, 그리고 Z 축 시스템 6, 회전를 포함 하 여 조정 할 수 피치 롤. 따라서, 기술자 조정 확증 해야 합니다.</li>
		<li>기록 하 고 매일 조정에 대 한 매개 변수를 출력. 참고: 경우에 종양 위치 6 축 중 하나에 5 m m의 공차 한계 넘어 이동, 환자 해야 될 재배치.</li>
	</ol>
</li>
	<li>방사선 치료를 제공 합니다. 치료 계획 및 시스템 구성을 확인 합니다. 치료를 시작 하려면 이동을 클릭 합니다. 전체 치료 기간 동안 환자의 안전을 보장 하기 위해 실시간 카메라를 사용 하 여 환자를 모니터링 합니다.</li>
</ol>

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저자 아무 공개 있다.

호흡 유도 간 기형 기관 모션 (대상 묘사) 컨투어링 문제 뿐 아니라 방사선 납품과 관련 된 어려움에 공헌 한다. 기관 모션 관리에 사용 되는 기술에 개선 개선 치료 정확도와 정밀도, SBRT에 기본적인 끌고있다. 여러 이미지 기반 기술 및 호흡기 모션 관리 시스템을 현재 사용할 수 있습니다. 표준 마커 이식 대상 지역화에 대 한 일반적인 기법입니다. 표준 마커는 일반적으로 원통형 골드 씨앗, 2.5 ~ ...

전통적으로, 전이 암의 터미널 단계 이라고 여겨진다 고 가난한 예 후 및 생존 관련 된. 그러나, 산 외. 1984 년에는 그들의 20 년 경험에의 하면 폐 전이의 완전 한 외과 제거 결과 상대적으로 높은 생존 율에 사이트가 일 경우 기본 종양 조직의 통제 수술1시간에 보도 했다. 헬 맨 및 1995 첫번째 제안된 oligometastases, 지역화 된 병 변 및 추가 로컬 치료2,3를 사용 하 여 치료 될 수 있다 polymetastases와 조직의 질병 사이 중간 단계에서 Weichselbaum. 지난 수 십년 동안 전이, oligometastases (metastasectomy), 그리고 효과적인 화학 요법 치료에 대 한 새로운 수술 방법의 조기 발견 전이 환자에서 예 후를 개선 했습니다. 간 단단한 종양에 대 한 가장 일반적인 전이성 기관 중 하나 이며 간 oligometastases의 외과 절제는 생존을 향상 시킬 수 있습니다. 로컬 제거 방법은, 고주파, radioembolization, 및 간 전이 치료를 위한 방사선 치료를 포함 하 여 필요한 로컬 종양 제어3,4 를 달성 하기 위해 작동 일부 환자에 대 한 추천 , 5 , 6 , 7. 지난 몇 년 동안, 몇몇 잠재 및 회고전 연구와 쾌활 정위 적 절제 방사선 치료 라고도 몸 정위 적 방사선 치료 (SBRT) 통해 간 전이의 효과적인 현지 종양 제어 보고 독성4,5,,89.
환자 위치 및 동원 정지 방법;에서 향상 되었습니다. 이미지 수집, 통합 및 전송 방사선 치료 시스템; 호흡기 모션 관리; 높은 복용량 출력과 빠른 방사선 납품; 그리고 주위 정상 조직에 대상 병 변에서 가파른 복용량 그라디언트. 이러한 발전으로 인해 SBRT 최소한의 심각한 독성10,11매우 정확 하 고 정확한 방사선 치료를 달성 한다. 호흡기 모션 관리 SBRT, 특히 간 및 폐 병 변에 대 한 근본 이다. 비 침 투 고 임상 호흡기 관리 기술을 실질적으로 치료 옵션으로 SBRT의 인기를 증가 했다. 이 문서는 간 전이 대 한 이미지 기반 지원 및 간 모션 관리 복 부 압축기 (AC)와 4 차원 단층 (4 D-코네티컷)를 사용 하는 SBRT 프로토콜을 자세히 설명 합니다.

<table border="0" cellpadding="0" cellspacing="0" width="875">
	<tbody>
		<tr height="51">
			<td height="51" style="height:51px;width:195px;">CT scan</td>
			<td style="width:188px;">Philips</td>
			<td style="width:265px;">Brilliance&#160;Big Bore&#160;16 Slice&#160;CT, 7387</td>
			<td style="width:228px;">Acquire CT images for contouring and planning</td>
		</tr>
		<tr height="51">
			<td height="51" style="height:51px;width:195px;">CT contrast</td>
			<td style="width:188px;">GE Healthcare</td>
			<td style="width:265px;">Omnipaque 350 mg L/mL</td>
			<td style="width:228px;">Enhence lesion in CT images</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Linear accelerator</td>
			<td>Elekta</td>
			<td>Synergy</td>
			<td>Deliver radiotherapy</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Palnning system</td>
			<td>Pinnacle</td>
			<td>Pinnacle 9.8</td>
			<td>Implement radiotherapy planning</td>
		</tr>
		<tr height="65">
			<td height="65" style="height:65px;width:195px;">Immobilization: BlueBag BodyFix</td>
			<td>Elekta</td>
			<td>900 mm x 2325 mm, P10104840</td>
			<td>Immobilize the patient</td>
		</tr>
		<tr height="66">
			<td height="66" style="height:66px;width:195px;">Immobilization: BodyFix Cover sheet</td>
			<td>Elekta</td>
			<td>2700 mm x 1400 mm, P10102-304</td>
			<td>Immobilize the patient</td>
		</tr>
		<tr height="73">
			<td height="73" style="height:73px;width:195px;">Immobilization: BodyFix abdominal compressor</td>
			<td>Elekta</td>
			<td>diaphragm control, P10102-149</td>
			<td style="width:228px;">Restrict breath motion and organ/lesion motion</td>
		</tr>
		<tr height="57">
			<td height="57" style="height:57px;width:195px;">Immobilization: vacuum pump</td>
			<td>Elekta</td>
			<td>vacuum pump, p2 120V, P10102-110</td>
			<td style="width:228px;">Shape body bag and cover sheet according to the patient</td>
		</tr>
	</tbody>
</table>

treatment of liver metastases using an internal target volume method for stereotactic body radiotherapy

전이성 암 환자의 예 후는 효과적인 화학 요법과 oligometastatic 수술 때문에 과거 십 년간에서 향상 되었습니다. 작동 환자에 대 한 로컬 제거 치료, 정위 적 몸 방사선 치료 (SBRT) 등 최소한의 독성으로 효과적인 현지 종양 통제를 제공할 수 있습니다. 높은 정밀도 및 정확도 SBRT 분수 당 더 높은 방사선 복용량을 제공, 더 효과적 이며 더 작은 방사선 볼륨 보다 기존의 방사선 치료 대상. 또한, 주변 정상 조직의 대상 병 변에서 가파른 복용량 그라디언트 SBRT;를 사용 하 여 달성 된다 따라서, SBRT 더 효과적인 종양 제어를 제공 하 고 기존 방사선 치료 보다 더 적은 부작용을 전시. SBRT 사용 (정위 적 radiosurgery로 알려진); intracranial 병 변 치료를 위한 유행 이다 그러나, 그것은 지금 또한 사용 척추 부 신 전이 치료. 이미지 기반 지원 및 호흡기 모션 관리 발전, 때문에 여러 연구 환자 통풍이 이동 폐 나 간 종양 치료를 위한 SBRT 사용 하 여를 조사 했습니다. 이러한 연구의 결과 SBRT 호의 장애를 이동 하는 경우 종양 제어 제안 했다.
복 부 압축기 (AC)와 4 차원 컴퓨터 단층 촬영 (4 D-코네티컷)은 임상적으로 효과적인 호흡 움직임 관리에 대 한 편리 합니다. 이 메서드는 비 침범 성 하 무료 호흡을 하기 때문에 그것의 사용 합병증을 감소 시킨다. 또한, 환자 고려이 방법은 편리 합니다. 또한, 그것 여겨진다 호흡기 모션 관리의 다른 방법 보다 더 효율적인 의사와 치료사에 의해. 폐 병 변 치료에 대 한 4 D-CT는 ac를 사용 하 여 광범위 하 게 조사도 하 고 기술 간 병 변 치료에 대 한 동의 얻고 있다. 그러나, 간 병 변 치료를 위한 AC를 4 D CT를 사용 하기 위한 프로토콜 폐 병 변 치료에 사용 되에서 다르다. 이 문서에서는, 우리 4 D CT와 치료 간 전이 대 한 AC SBRT에 대 한 새로운 프로토콜을 설명합니다.

SBRT 강렬한 변조 방사선 치료 (IMRT)에 의해 구현 될 수 있습니다 (와 함께 <img alt="image" src="/files/ftp_upload/57050/57050imgv2.jpg"> 6 방사선 광속) 또는 체적 아크 방사선 치료 (VMAT) (와 함께 지속적인 복용량 배달 및 갠트리 회전) 때문에 단일 수술 수 있습니다 단일 치료에서 모든 대상을 커버 모든 종양의 제거를 달성 하지. 대표 SBRT 치료 계획 성공적인 방사선 치료 수술 가능 하지 ?...

Watch this Scientific Journal Video about Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy at JoVE.com

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

몸 정위 적 방사선 치료 (SBRT) 종양 제어를 개선 하 고 동시에 독성을 줄일 작은 치료 볼륨 분수 당 높은 방사선 복용량을 전달 하기 위한 엄격한 정확성과 정밀도 요구 한다. 여기, 우리는 현재 임상 편리 하 고 비 침 투 적인 호흡기 모션 관리 프로토콜 SBRT에 대 한 간 전이 대 한.

몸 정위 적 방사선 치료에 대 한 내부 대상 볼륨 메서드를 사용 하 여 간 전이의 치료

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

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Research

JoVE Journal

Medicine

14.0K 조회수.  Taipei Medical University Hospital. 몸 정위 적 방사선 치료 (SBRT) 종양 제어를 개선 하 고 동시에 독성을 줄일 작은 치료 볼륨 분수 당 높은 방사선 복용량을 전달 하기 위한 엄격한 정확성과 정밀도 요구 한다. 여기, 우리는 현재 임상 편리 하 고 비 침 투 적인 호흡기 모션 관리 프로토콜 SBRT에 대 한 간 전이 대 한.

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

Combination Radiotherapy in an Orthotopic Mouse Brain Tumor Model

Glioblastoma multiforme (GBM) are the most common and aggressive adult primary brain tumors1. In recent years there has been substantial progress in the understanding of the mechanics of tumor invasion, and direct intracerebral inoculation of tumor provides the opportunity of observing the invasive process in a physiologically appropriate environment2. As far as human brain tumors are concerned, the orthotopic models currently available are established either by stereotaxic injection of cell suspensions or implantation of a solid piece of tumor through a complicated craniotomy procedure3. In our technique we harvest cells from tissue culture to create a cell suspension used to implant directly into the brain. The duration of the surgery is approximately 30 minutes, and as the mouse needs to be in a constant surgical plane, an injectable anesthetic is used. The mouse is placed in a stereotaxic jig made by Stoetling (figure 1). After the surgical area is cleaned and prepared, an incision is made; and the bregma is located to determine the location of the craniotomy. The location of the craniotomy is 2 mm to the right and 1 mm rostral to the bregma. The depth is 3 mm from the surface of the skull, and cells are injected at a rate of 2 &mu;l every 2 minutes. The skin is sutured with 5-0 PDS, and the mouse is allowed to wake up on a heating pad. From our experience, depending on the cell line, treatment can take place from 7-10 days after surgery. Drug delivery is dependent on the drug composition. For radiation treatment the mice are anesthetized, and put into a custom made jig. Lead covers the mouse's body and exposes only the brain of the mouse. The study of tumorigenesis and the evaluation of new therapies for GBM require accurate and reproducible brain tumor animal models. Thus we use this orthotopic brain model to study the interaction of the microenvironment of the brain and the tumor, to test the effectiveness of different therapeutic agents with and without radiation.

The purpose of this article is to describe the use of an orthotopic glioblastoma model for chemoradiation studies. This article will go though cell processing, implanting, and radiotherapy of the mouse using an intracranial model.

Orthotopic 마우스 뇌종양 모델의 조합 방사선 치료

Glioblastoma multiforme (GBM) are the most common and aggressive adult primary brain tumors1. In recent years there has been substantial progress in the ...

연구

의학

Stereotactic Radiosurgery for Gynecologic Cancer

Stereotactic body radiotherapy (SBRT) distinguishes itself by necessitating more rigid patient immobilization, accounting for respiratory motion, intricate treatment planning, on-board imaging, and reduced number of ablative radiation doses to cancer targets usually refractory to chemotherapy and conventional radiation. Steep SBRT radiation dose drop-off permits narrow 'pencil beam' treatment fields to be used for ablative radiation treatment condensed into 1 to 3 treatments.
Treating physicians must appreciate that SBRT comes at a bigger danger of normal tissue injury and chance of geographic tumor miss. Both must be tackled by immobilization of cancer targets and by high-precision treatment delivery. Cancer target immobilization has been achieved through use of indexed customized Styrofoam casts, evacuated bean bags, or body-fix molds with patient-independent abdominal compression.1-3 Intrafraction motion of cancer targets due to breathing now can be reduced by patient-responsive breath hold techniques,4 patient mouthpiece active breathing coordination,5 respiration-correlated computed tomography,6 or image-guided tracking of fiducials implanted within and around a moving tumor.7-9 The Cyberknife system (Accuray [Sunnyvale, CA]) utilizes a radiation linear accelerator mounted on a industrial robotic arm that accurately follows patient respiratory motion by a camera-tracked set of light-emitting diodes (LED) impregnated on a vest fitted to a patient.10 Substantial reductions in radiation therapy margins can be achieved by motion tracking, ultimately rendering a smaller planning target volumes that are irradiated with submillimeter accuracy.11-13
Cancer targets treated by SBRT are irradiated by converging, tightly collimated beams. Resultant radiation dose to cancer target volume histograms have a more pronounced radiation "shoulder" indicating high percentage target coverage and a small high-dose radiation "tail." Thus, increased target conformality comes at the expense of decreased dose uniformity in the SBRT cancer target. This may have implications for both subsequent tumor control in the SBRT target and normal tissue tolerance of organs at-risk. Due to the sharp dose falloff in SBRT, the possibility of occult disease escaping ablative radiation dose occurs when cancer targets are not fully recognized and inadequate SBRT dose margins are applied. Clinical target volume (CTV) expansion by 0.5 cm, resulting in a larger planning target volume (PTV), is associated with increased target control without undue normal tissue injury.7,8 Further reduction in the probability of geographic miss may be achieved by incorporation of 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET).8 Use of 18F-FDG PET/CT in SBRT treatment planning is only the beginning of attempts to discover new imaging target molecular signatures for gynecologic cancers.

Stereotactic body radiotherapy (SBRT) involves image-guided, ablative radiation delivered to cancer targets refractory to chemotherapy or to conventional radiation treatment. The robotic-armed Cyberknife SBRT system, using sophisticated target localization, delivers hypofractionated radiation doses capable of sterilizing cancer targets. This article will consider new therapeutic roles of SBRT for gynecological cancers.

Gynecologic 암에 대한 Stereotactic Radiosurgery의

Stereotactic body radiotherapy (SBRT) distinguishes itself by necessitating more rigid patient immobilization, accounting for respiratory motion, ...

Ex Vivo Treatment Response of Primary Tumors and/or Associated Metastases for Preclinical and Clinical Development of Therapeutics

The molecular analysis of established cancer cell lines has been the mainstay of cancer research for the past several decades. Cell culture provides both direct and rapid analysis of therapeutic sensitivity and resistance. However, recent evidence suggests that therapeutic response is not exclusive to the inherent molecular composition of cancer cells but rather is greatly influenced by the tumor cell microenvironment, a feature that cannot be recapitulated by traditional culturing methods. Even implementation of tumor xenografts, though providing a wealth of information on drug delivery/efficacy, cannot capture the tumor cell/microenvironment crosstalk (i.e., soluble factors) that occurs within human tumors and greatly impacts tumor response. To this extent, we have developed an ex vivo (fresh tissue sectioning) technique which allows for the direct assessment of treatment response for preclinical and clinical therapeutics development. This technique maintains tissue integrity and cellular architecture within the tumor cell/microenvironment context throughout treatment response providing a more precise means to assess drug efficacy.

Ex Vivo Treatment Response of Primary Tumors and/or Associated Metastases for Preclinical and Clinical Development of Therapeutics

Established cancer cell lines and xenografts have been the mainstay of cancer research for the past several decades. However, recent evidence suggests that therapeutic response is greatly influenced by the tumor cell microenvironment. Therefore, we have developed an ex vivo analysis of primary tumor specimens for drug development purposes.

기본 종양 및 / 또는 전임상에 대한 관련 전이 및 치료제의 임상 개발의 전 생체 치료 응답

The molecular analysis of established cancer cell lines has been the mainstay of cancer research for the past several decades. Cell culture provides both ...

Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic agent melphalan. Briefly, the procedure starts with the setup of a percutaneous veno-venous bypass from the femoral vein to the external jugular vein. Via a laparotomy, catheters are then inserted into the proper hepatic artery and the caval vein. The portal vein and the caval vein, both supra- and infrahepatically, are then clamped. The arterial and venous catheters are connected to a heart lung machine and the liver is perfused with melphalan (1 mg/kg body weight) for 60 min. This way it is possible to locally perfuse the liver with a high dose of a chemotherapeutic agent, without leakage to the systemic circulation.
In previous studies including patients with isolated liver metastases of uveal melanoma, an overall response rate of 33-100% and a median survival between 9 and 13 months, have been reported. The aim of this protocol is to give a clear description of how to perform the procedure and to discuss IHP as a treatment option for liver metastases of uveal melanoma.

Here, we present a protocol how to perform an isolated liver perfusion (IHP) with melphalan and we also discuss IHP as a treatment option for liver metastases of uveal melanoma.

포도막 흑색 종의 간전이에 대한 치료로 고립 간 관류

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic ...

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.

정위 절제 바디 방사선 치료에 대한 동적 폐 종양 추적

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

An Improved Method for Rapid Intubation of the Trachea in Mice

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity is a commonly used model to study both acute lung injury and fibrosis, and multiple methods have been developed for administering bleomycin (and other toxic agents) into the lungs. However, many of these approaches, such as transtracheal instillation, have inherent drawbacks, including the need for strong anesthetics and survival surgery. This paper reports a quick, reproducible method of intratracheal intubation that involves mild inhaled anesthesia, visualization of the trachea, and the use of a surrogate spirometer to confirm exposure. As a proof of concept, 8-12 week old C57BL/6 mice were administered either 2.0 U/kg of bleomycin or an equivalent volume of PBS, and both damage and fibrotic endpoints were measured post-exposure. This procedure allows researchers to treat a large cohort of mice in a relatively short period with little expense and minimal post-procedure care.

This article presents a rapid and simple method for administering bleomycin directly into the mouse trachea via intubation. Key advantages of this method are that it is highly reproducible, easy to master, and does not require specialized equipment or lengthy recovery times.

마우스의기도 신속 삽관 용 개선 된 방법

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity ...

Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn unresectable metastases into resectable ones. Some patients however, suffer from side effects or progression under systemic treatment. For patients with metastasized uveal melanoma there are no standard systemic therapy options. For patients without extrahepatic disease, isolated liver perfusion (IHP) may enable local disease control with limited systemic side effects. Previously, this was performed during open surgery with satisfying results, but morbidity and mortality related to the open procedure, prohibited a widespread application. Therefore, percutaneous hepatic perfusion (PHP) with simultaneous chemofiltration was developed. Besides decreasing morbidity and mortality, this procedure can be repeated, hopefully leading to a higher response rate and improved survival (by local control of disease). During PHP, catheters are placed in the proper hepatic artery, to infuse the chemotherapeutic agent, and in the inferior caval vein to aspirate the chemosaturated blood returning through the hepatic veins. The caval vein catheter is a double balloon catheter that prohibits leakage into the systemic circulation. The blood returning from the hepatic veins is aspirated through the catheter fenestrations and then perfused through an extra-corporeal filtration system. After filtration, the blood is returned to the patient by a third catheter in the right internal jugular vein. During PHP a high dose of melphalan is infused into the liver, which is toxic and would lead to life threatening complications when administered systemically. Because of the significant hemodynamic instability resulting from the combination of caval vein occlusion and chemofiltration, hemodynamic monitoring and hemodynamic support is of paramount importance during this complex procedure.

Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

In this manuscript, we describe percutaneous isolated hepatic perfusion with simultaneous chemofiltration as treatment for unresectable liver metastases. This procedure is performed under general anaesthesia in the angiosuite by an experienced team, consisting of an interventional radiologist, a clinical perfusionist and anaesthesiologist.

간으로 밀폐 절제 불가능한 전이에 대한 치료로 멜 팔란과 경피적 간 관류 (PHP)

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn ...

Method of Direct Segmental Intra-hepatic Delivery Using a Rat Liver Hilar Clamp Model

Major hepatic surgery with inflow occlusion, and liver transplantation, necessitate a period of warm ischemia, and a period of reperfusion leading to ischemia/reperfusion (I/R) injury with myriad negative consequences. Potential I/R injury in marginal organs destined for liver transplantation contributes to the current donor shortage secondary to a decreased organ utilization rate. A significant need exists to explore hepatic I/R injury in order to mediate its impact on graft function in transplantation. Rat liver hilar clamp models are used to investigate the impact of different molecules on hepatic I/R injury. Depending on the model, these molecules have been delivered using inhalation, epidural infusion, intraperitoneal injection, intravenous administration or injection into the peripheral superior mesenteric vein. A rat liver hilar clamp model has been developed for use in studying the impact of pharmacologic molecules in ameliorating I/R injury. The described model for rat liver hilar clamp includes direct cannulation of the portal supply to the ischemic hepatic segment via a side branch of the portal vein, allowing for direct segmental hepatic delivery. Our approach is to induce ischemia in the left lateral and median lobes for 60 min, during which time the substance under study is infused. In this case, pegylated-superoxide dismutase (PEG-SOD), a free radical scavenger, is infused directly into the ischemic segment. This series of experiments demonstrates that infusion of PEG-SOD is protective against hepatic I/R injury. Advantages of this approach include direct injection of the molecule into the ischemic segment with consequent decrease in volume of distribution and reduction in systemic side effects.

A unique rat liver hilar clamp model was developed for studying the impact of pharmacologic molecules in ameliorating ischemia-reperfusion injury. This model includes direct cannulation of the portal supply to the ischemic liver segment via a branch of the portal vein, allowing for direct hepatic delivery.

쥐 간 문부 클램프 모델을 사용하여 직접 분절 인트라 간 납품 방법

Major hepatic surgery with inflow occlusion, and liver transplantation, necessitate a period of warm ischemia, and a period of reperfusion leading to ...

Radiation Planning Assistant - A Streamlined, Fully Automated Radiotherapy Treatment Planning System

The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated arc therapy (VMAT) plans for patients with head/neck cancer and 4-field box plans for patients with cervical cancer. It is a combination of specially developed in-house software that uses an application programming interface to communicate with a commercial radiotherapy treatment planning system. It also interfaces with a commercial secondary dose verification software. The necessary inputs to the system are a Treatment Plan Order, approved by the radiation oncologist, and a simulation computed tomography (CT) image, approved by the radiographer. The RPA then generates a complete radiotherapy treatment plan. For the cervical cancer treatment plans, no additional user intervention is necessary until the plan is complete. For head/neck treatment plans, after the normal tissue and some of the target structures are automatically delineated on the CT image, the radiation oncologist must review the contours, making edits if necessary. They also delineate the gross tumor volume. The RPA then completes the treatment planning process, creating a VMAT plan. Finally, the completed plan must be reviewed by qualified clinical staff.

Radiation therapy is a highly complex cancer treatment that requires multiple specialists to create a treatment plan and provide quality assurance (QA) prior to delivery to a patient. This protocol describes the use of a fully automated system, the Radiation Planning Assistant (RPA), to create high-quality radiation treatment plans.

방사선 계획 도우미-유선형된, 완전 자동화 된 방사선 치료 계획 시스템

The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated ...

Predicting Treatment Response to Image-Guided Therapies Using Machine Learning: An Example for Trans-Arterial Treatment of Hepatocellular Carcinoma

Intra-arterial therapies are the standard of care for patients with hepatocellular carcinoma who cannot undergo surgical resection. The objective of this study was to develop a method to predict response to intra-arterial treatment prior to intervention.
The method provides a general framework for predicting outcomes prior to intra-arterial therapy. It involves pooling clinical, demographic and imaging data across a cohort of patients and using these data to train a machine learning model. The trained model is applied to new patients in order to predict their likelihood of response to intra-arterial therapy.
The method entails the acquisition and parsing of clinical, demographic and imaging data from N patients who have already undergone trans-arterial therapies. These data are parsed into discrete features (age, sex, cirrhosis, degree of tumor enhancement, etc.) and binarized into true/false values (e.g., age over 60, male gender, tumor enhancement beyond a set threshold, etc.). Low-variance features and features with low univariate associations with the outcome are removed. Each treated patient is labeled according to whether they responded or did not respond to treatment. Each training patient is thus represented by a set of binary features and an outcome label. Machine learning models are trained using N - 1 patients with testing on the left-out patient. This process is repeated for each of the N patients. The N models are averaged to arrive at a final model.
The technique is extensible and enables inclusion of additional features in the future. It is also a generalizable process that may be applied to clinical research questions outside of interventional radiology. The main limitation is the need to derive features manually from each patient. A popular modern form of machine learning called deep learning does not suffer from this limitation, but requires larger datasets.

Intra-arterial therapies are the standard of care for patients with hepatocellular carcinoma who cannot undergo surgical resection. A method for predicting response to these therapies is proposed. The technique uses pre-procedural clinical, demographic, and imaging information to train machine learning models capable of predicting response prior to treatment.

기계 학습을 사용 하 여 이미지 기반 요법 치료 반응 예측: 간세포 암 종의 트랜스 동맥 치료 예

Intra-arterial therapies are the standard of care for patients with hepatocellular carcinoma who cannot undergo surgical resection. The objective of this ...