Center for Interventional Oncology

NIH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受限肿瘤患者的新的局部、区域或联合癌症治疗方法。实现这一目标的机制将包括影像科学家、介入放射科医生、肿瘤学家(外科、内科、放射或泌尿外科)、生物学家和工程师之间的合作。CIO将提供一个翻译环境，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合作团队来解决。在美国国立卫生研究院临床中心和壁内研究计划的背景下，微创疗法通常成本更低、更安全、更容易翻译和广泛应用。新的介入肿瘤学中心(CIO)于2009财年第三季度至第四季度在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CC、国家癌症研究所(NCI)、国家心、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)的合作伙伴。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准的靶向和最小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医学之间的差距。先进的成像方法开启了一个更早发现癌症的时代，这些癌症往往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，以增加标准的癌症治疗选择：全身化疗、手术和放射治疗。CIO调查人员将利用CC的跨学科转换环境来调查和优化如何以及何时组合药物、设备和多模式成像导航。例如，“可激活的”药物可以被注射到静脉或动脉中，然后使用“医用GPS”用针或导管直接部署在肿瘤内，这项技术使医生能够使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)或超声波，以实时可视化的方式在体内导航。早些时候捕获的图像可以重复使用，以指导设备将靶向治疗送到疾病的位置，使这一过程更具成本效益，因为它不需要用于记录第一张图像的系统物理存在。例如，先前的前列腺癌MRI可以通过使用启用了医用GPS的针头和超声波来帮助引导活检或局部消融，而不需要、占用或在手术期间占用或捆绑MRI系统。在另一个例子中，可以使用细针或声波来消融肿瘤并增强靶向药物输送。能源包括高强度聚焦超声波、冷冻、微波、激光和射频。研究人员还扩大了对图像引导的药物输送或图像引导的“剂量画”的研究，即通过将靶向的、可激活的药物与局部能量或热量相结合，将药物部署在特殊设计的纳米颗粒中，从而使用图像向特定区域开出特定的药物剂量。该中心提供了一个论坛，鼓励内科、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为这种类型的协作翻译研究和患者护理提供了一个特殊的环境。其他主要计划内容包括开发新的图像引导方法，用于个性化药物调查(或在药物发现期间跟踪组织对研究药物的反应)，以及涉及新药、设备、图像引导机器人辅助、分子探测器和纳米粒子的第一次人类调查。许多肿瘤学家目前既不熟悉也不受过基于图像的局部治疗方法的培训。与此同时，介入放射科医生可能缺乏肿瘤学方面的正规培训。因此，教育和交叉培训是该计划的另一个重要部分。不同学科之间、研究努力和病人护理之间以及诊断和治疗之间存在重大差距。这些间隙可以通过先进的成像方法进行整合，以进行局部治疗。此外，与这些早期疾病检测和治疗范例相适应的介入肿瘤学跨学科培训计划尚不存在，但将加强现有计划，并强调NIH独特的翻译氛围，在那里，病床到床边是规则。CIO的协作活动由一个指导委员会指导，指导委员会的意见来自多个IC，总部设在临床中心放射和成像科学部。具体目标包括：1.发展介入肿瘤学方面的培训和教育2.为智能活组织检查和生物标记物采购开发新的图像引导方法，以支持有针对性的治疗3.使用新的微创介入肿瘤学技术支持患者护理4.在介入肿瘤学方面进行新技术和新技术的研究这一新计划处于理想和独特的位置，可以提供一个结合培训、患者护理和转译研究的跨学科环境，以加速介入肿瘤学和分子针对性干预的进展。

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 and 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.