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局部或器官局限性肿瘤患者的新型局部，区域或联合癌症疗法。实现这一目标的机制将包括成像科学家、介入放射科医生、肿瘤学家（外科、内科、放射科或泌尿科）、生物学家和工程师之间的合作。CIO将提供一个转化环境，其中肿瘤学的临床缺点被确定，然后由开发新技术和方法的协作团队解决。微创治疗通常成本更低，更安全，易于翻译，并广泛应用于NIH临床中心和校内研究项目。新的介入肿瘤学中心（CIO）于2009财年第3 -4季度在NIH临床中心（CC）成立，旨在开发和翻译用于局部癌症治疗的图像引导技术。该中心是由CC，国家癌症研究所（NCI），国家心脏，肺和血液研究所（NHLBI）以及国家生物成像和生物工程研究所（NIBIB）合作的。该中心将利用每个研究所的优势，研究成像技术和先进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以及新兴技术和程序医学之间的差距。先进的成像方法开创了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，以增加标准癌症治疗选择：全身化疗，手术和放疗。CIO调查人员将利用CC的跨学科翻译环境，调查和优化如何以及何时将联合收割机药物、设备和多模式成像导航结合起来。例如，“可活化”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，该技术使医生能够使用最新的先进成像技术（例如磁共振成像（MRI）、正电子发射断层扫描（PET）、计算机断层扫描（CT）或超声波）通过实时可视化在体内导航。早期捕获的图像可以重复使用，以引导设备将靶向治疗提供到疾病位置，使手术更具成本效益，因为它不需要用于记录第一张图像的系统实际存在。例如，之前的前列腺MRI可以通过使用支持“医疗GPS”的针头和超声来帮助引导活检或局灶性消融，而无需在手术过程中占用或捆绑MRI系统。在另一个实例中，细针或声波可用于消融肿瘤并增强靶向药物递送。能量来源包括高强度聚焦超声、冷冻、微波、激光和射频。研究人员还将研究扩展到图像引导的药物输送或图像引导的“剂量绘画”，其中图像可用于向特定区域规定特定的药物剂量，通过将靶向的可激活药物与局部能量或热量结合，将药物部署在特别设计的纳米颗粒中。该中心提供了一个论坛，以鼓励研究人员和病人护理专家之间的合作，在医疗，外科，泌尿外科，放射肿瘤学和介入放射学。CC为这种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新的图像引导方法，用于个性化药物研究（或在药物发现期间跟踪组织对研究药物的反应）和首次人体研究，涉及新药，设备，图像引导机器人辅助，分子探针和纳米颗粒。许多肿瘤学家目前不熟悉基于图像的局部治疗方法，也没有接受过这方面的培训。与此同时，介入放射科医生可能缺乏正规的肿瘤学培训。因此，教育和交叉培训是该计划的另一个重要组成部分。不同学科之间、研究工作与患者护理之间以及诊断与治疗之间存在重大差距。间隙可以通过用于局部治疗的先进图像方法来整合。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计划尚不存在，但将增强现有计划，并强调NIH独特的翻译氛围，在那里，从实验室到床边是规则。首席信息官的协作活动由指导委员会指导，并由临床中心放射学和成像科学部门的多个IC提供输入。具体目标包括：1.开展介入肿瘤学的培训和教育2.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3。使用新型微创介入肿瘤学技术支持患者护理4.在新的技术和技术在介入肿瘤学追求研究这个新的程序是理想的，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，以加快在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，和实际交付的翻译多学科的范例，以满足特定的临床需求。

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 mechanisms by which this goal will be achieved will include collaborations between imaging scientists, interventional radiologists, oncologists (surgical, medical, radiation, or urological), biologists and engineers. The CIO will provide 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 new Center for Interventional Oncology (CIO) was established in Q3-4 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, National Cancer Institute (NCI), the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute of Bioimaging and Bioengineering (NIBIB). The Center will draw on the strengths of each institute to investigate how imaging technologies and advanced 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 cancer treatment options: systemic 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), or ultrasound. Images captured earlier can be 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 system used to record the first 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 "dose painting," where the image can be used to prescribe a particular drug dose 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, molecular probes, and nanoparticles. Many oncologists are not currently familiar with, nor trained in, image based, localized treatment approaches. At the same time, interventional radiologists may lack formal training in oncology. Therefore, 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. The CIO's collaborative activities are guided by a steering committee with input from multiple ICs with the home-base in the Clinical Centers Radiology and Imaging Sciences Department. 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 new 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 deliverables of translation of multidisciplinary paradigms that meet specific clinical needs.