Center for Interventional Oncology

美国国立卫生研究院介入肿瘤学中心是一个跨学科的努力，其主要目标是开发和更好地定义新的局部、区域或联合癌症治疗，用于局部或器官局限性肿瘤患者。这些目标是通过成像科学家、介入放射科医生、肿瘤学家（外科、医学、放射或泌尿科）、生物学家、化学家和工程师之间的合作来实现的。CIO提供了一个转化环境，在这个环境中，肿瘤学的临床缺陷被识别出来，然后由一个开发新技术和技术的协作团队来解决。微创治疗通常成本更低，更安全，易于转化，并广泛应用于NIH临床中心和校内研究项目。介入肿瘤学中心（CIO）于2009年末在美国国立卫生研究院临床中心（CC）成立，旨在开发和转化用于局部癌症治疗的图像引导技术。该中心是由CC和国家癌症研究所（NCI）（以及较小程度上的NIBIB）合作建立的。该中心利用每个合作伙伴的优势，研究成像技术和设备如何以精确靶向和微创或非侵入性的方式诊断和治疗局部癌症。它还将有助于弥合诊断和治疗之间的差距，以及新兴技术和程序性医学之间的差距。先进的成像技术开创了一个早期检测癌症的时代，这些癌症通常局限于单个器官或区域。介入肿瘤学通常为癌症患者提供局部或区域治疗选择，以增加标准的全身治疗选择，如化疗，手术和放疗。CIO研究人员将利用CC的跨学科、转化环境来调查和优化如何以及何时结合药物、设备和多模态成像导航。例如，“可激活”药物可以注射到静脉或动脉中，然后使用“医疗GPS”用针或导管直接部署在肿瘤中，这项技术使医生能够利用最新的先进成像技术，如磁共振成像（MRI）、正电子发射断层扫描（PET）、计算机断层扫描（CT）、锥束CT （CBCT）或超声波，实时可视化地导航身体。手术前的图像被重复使用，以指导设备将靶向治疗送到疾病的位置，使该过程更具成本效益，因为它不需要用于记录图像的MRI， CT或PET系统。例如，先前的前列腺MRI可以通过使用“医疗GPS”启用针和超声来帮助引导活检或局灶消融，而无需在过程中占用或捆绑MRI系统。在另一个例子中，细针或声波可用于消融肿瘤并增强靶向药物输送。能量来源包括高强度聚焦超声、冷冻、微波、激光和射频。研究人员还扩大了对图像引导药物输送或图像引导“药物绘画”的研究，通过将靶向的、可激活的药物与局部能量或热量结合起来，将药物部署在专门设计的纳米颗粒中，图像可以用来给特定区域开一种特定的药物。该中心提供了一个论坛，鼓励医学、外科、泌尿外科、放射肿瘤学和介入放射学领域的研究人员和患者护理专家之间的合作。CC为这种类型的合作转化研究和患者护理提供了一个特殊的环境。其他主要项目包括开发用于个性化药物研究的新图像引导方法（或在药物发现期间跟踪研究药物的组织反应）和涉及新药、设备、图像引导机器人辅助和纳米颗粒的首次人体研究。靶向序贯活检是药物发现或生物标志物表征的有力工具。教育和交叉培训是该计划的另一个重要部分。各个学科之间、研究工作与病人护理之间、诊断与治疗之间存在着显著的差距。这些间隙可以通过先进的图像方法进行局部治疗。此外，适合这些早期疾病检测和治疗范例的介入肿瘤学跨学科培训项目尚不存在，但将增强现有项目，并强调NIH独特的转化氛围，在这里，从实验室到床边是规则。具体目标包括：1。开展介入肿瘤学的培训和教育。开发新的图像引导方法，用于智能活检和生物标志物采购，以支持靶向治疗。使用新型微创介入肿瘤学技术支持患者护理。从事介入肿瘤学新技术的研究。这个项目是理想的和独特的定位，提供一个跨学科的环境，结合培训，病人护理和转化研究，以加速介入肿瘤学和分子靶向干预的进展。重点是翻译模型，翻译工具，和实际的可交付成果的翻译多学科范式，以满足特定的临床需要。

The NIH Center for Interventional Oncology is an interdisciplinary effort with the primary goal of developing and better defining novel local, regional, or combination cancer therapies in patients with localized or organ-confined neoplasms. The goals are achieved via collaborations between imaging scientists, interventional radiologists, oncologists (surgical, medical, radiation, or urological), biologists, chemists, and engineers. The CIO provides a translational environment wherein clinical shortcomings in oncology are identified, then addressed by a collaborative team that develop novel technologies and techniques. Minimally invasive therapies are often less costly, safer, and easy to translate and broadly apply in the setting of the NIH Clinical Center and Intramural Research Program. The Center for Interventional Oncology (CIO) was established in late FY 09 at the NIH Clinical Center (CC) to develop and translate image-guided technologies for localized cancer treatments. The Center is a collaboration involving the CC and the National Cancer Institute (NCI), [and to lesser extent NIBIB]. The Center draws on the strengths of each partner to investigate how imaging technologies and devices can diagnose and treat localized cancers in ways that are precisely targeted and minimally or non-invasive. It will also help bridge the gap between diagnosis and therapy, and between emerging technology and procedural medicine. Advanced imaging methods have ushered in an era of earlier detection of cancers that are frequently localized to a single organ or region. Interventional oncology often provides cancer patients with local or regional treatment options to augment the standard systemic treatment options like: chemotherapy, surgery, and radiation. CIO investigators will leverage the interdisciplinary, translational environment at the CC to investigate and optimize how and when to combine drugs, devices, and multimodal imaging navigation. For example, "activatable" drugs can be injected in a vein or artery, then deployed directly in the tumor with needles or catheters using "medical GPS", a technique that enables the physician to navigate through the body with real-time visualization using the latest advanced imaging technologies, such as magnetic resonance imaging (MRI), positron emission tomography (PET), computed tomography (CT), cone beam CT (CBCT), or ultrasound. Pre-procedural images are reused to guide devices delivering targeted therapy to the location of the disease, making the procedure more cost-effective because it doesn't require the MRI, CT or PET system used to record the image to be physically present. A prior prostate MRI, for example, can be used to help with guided biopsy or focal ablation by using a "medical GPS"-enabled needle and ultrasound, without requiring, occupying or tying up an MRI system during the procedure. In another example, a thin needle or sound waves can be used to ablate tumors and enhance targeted drug delivery. Energy sources include high-intensity focused ultrasound, freezing, microwaves, laser, and radiofrequency. Researchers also expand investigations into image-guided drug delivery or image-guided "drug painting," where the image can be used to prescribe a particular drug to a specific region, by combining targeted, activate-able drugs with localized energy or heat to deploy the drug within specially engineered nano-particles. The Center provides a forum to encourage collaborations among researchers and patient-care experts in medical, surgical, urologic, and radiation oncology and interventional radiology. The CC provides an exceptional environment for this type of collaborative translational research and patient care. Other major program components include the development of new image-guided methods for personalized drug investigations (or tracking tissue responses to investigational drugs during drug discovery) and first-in-human investigations involving new drugs, devices, image-guided robotic assistance, and nanoparticles. Targeted sequential biopsy is a powerful tool for drug discover or biomarker characterization. Education and cross-training is another important part of the program. Significant gaps exist between the various disciplines, between research efforts and patient care, and between diagnosis and treatment. The gaps may be integrated through advanced image methods for localized therapy. Further, cross-disciplinary training programs in interventional oncology suited to these early disease detect & treat paradigms do not yet exist, but would augment existing programs and underline the unique translational atmosphere at the NIH, where bench-to-bedside is the rule. Specific aims include: 1. Develop training and education in Interventional Oncology 2. Develop novel image-guided methods for smart biopsy and biomarker procurement to support targeted therapeutics 3. Support patient care using novel minimally invasive Interventional Oncology techniques 4. Pursue research in novel techniques and technologies in Interventional Oncology. This program is ideally and uniquely positioned to provide an interdisciplinary environment that combines training, patient care, and translational research to accelerate progress in interventional oncology and molecularly targeted interventions. The focus is upon translational models, translational tools, and actual practical deliverables of translation of multidisciplinary paradigms that meet specific clinical needs.