Interventional Oncology

点击翻译按钮获取中文摘要

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, such as the liver. Interventional oncology often provides cancer patients with local or regional treatment options to augment the standard systemic treatment options like: immunotherapy, 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 imaging system to be physically present to take advantage of the information contained within. 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, image-able-able or activate-able drugs with localized energy or heat to deploy the drug within specially engineered micro- or 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 micro- and nano-sized drug vectors. 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. CIO trainees augment existing training 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. A recent addition of deep learning in cancer was begun with the goal of integrating digital pathology, molecular and imaging information for specific cancers and cancer interventions. CIO managed 10 preclinical protocols and > 5 clinical protocols. CIO staff are due to receive 2 PhDs this fiscal year. The CIO has trained many students, residents, fellows, PhD candidates, junior faculty, visiting scientists, engineers, and collaborating scientists, who have successfully advanced in their academic careers and are practicing in interventional radiology, radiology, urology, radiation oncology, veterinary medicine, and various senior positions in academics and industry (see mentoring appendix). The Woodchuck HCC model was established and characterized for IR. Novel software and hardware was developed for patients: (Angle-Nav, OncoNav, PercuNav, UroNav, CystoNav, RenoNav, Airwaze, BronchMEMS). Augmented reality for smartphones made it to IR clinic. The AI Resource was established for an ecosystem for cancer. Fusion guided ablation was developed and deployed for the office setting, as was prostate biopsy with needle and ultrasound totally outside of the rectum. Smartphone interventions were brought to clinic. CIO accomplished the 1st in human use of artificial intelligence for segmentation and registration during a thermal ablation procedure, Transperineal hand held ultrasound fusion biopsy without a frame or stepper stage was reduced to practice, which is becoming more main stream already with rapid adoption. In the translational animal lab, CIO characterized woodchuck molecular immune correlates for woodchuck hepatitis-induced HCC, developed a drug delivery model for drug dose painting with fusion and image-able drug eluting beads (invented and developed at the NIH CIO), developed and reported topotecan drug eluting beads in rabbit VX2 liver tumors, characterized preclinical augmentation of check point inhibition with cryo in woodchuck liver cancer and cryo and RFA in mouse tumors in vivo, Multiple devices were developed including "Angle-Nav" MEMS clip to needle, Airwaze, BronchoMEMS, CystoNav. Augmented reality via smartphone was validated. Developed small molecule checkpoint inhibitor "drug eluting immuno-beads". Artificial intelligence deep learning models for classification of COVID-19 were developed and interfaced with PACS. Ultrasound tomography for the prostate was further developed with ex vivo human trials starting FY21. Raw analysis of ultrasound signal during prostate biopsy will validate an NIH-UBC-Queens CIHR funded collaboration on ultrasound computer aided detection for prostate cancer. Artificial intelligence efforts will focus on prostate liver and kidney cancer. Recent developments with NCI include a prostate segmentation model and an "autonomous driving radiologist" for standardized and AI enhanced detection and classification of prostate MRI lesions. The CIO continues to straddle the interface between multiple disciplines and encourages members and collaborators to fertilize the interdisciplinary lands in between the labels of specific fields or specializations, in order to truly meet the team science definition of truly multi-disciplinar