Shahrouki Puja, Lee Jay M, Barclay Jonathan, Khan Sarah N, Genshaft Scott, Abtin Fereidoun, Dubinett Steven M, Lisberg Aaron, Sharma Sherven, Garon Edward B, Suh Robert
Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
JTO Clin Res Rep. 2021 Oct 14;2(11):100242. doi: 10.1016/j.jtocrr.2021.100242. eCollection 2021 Nov.
INTRODUCTION: To assess the technical feasibility and safety of repeated percutaneous computed tomography (CT)-guided transthoracic biopsies and intratumoral injections of gene-modified dendritic cells in metastatic NSCLC. METHODS: A total of 15 patients with 15 NSCLC lesions measuring greater than 1.0 cm underwent two cycles of intratumoral biopsies and CCL21 dendritic cell injections separated by 7 days. All needle placements and injections were done under CT guidance. Clinical and imaging follow-up was done approximately 4 weeks after the first procedure. Safety and feasibility were determined as: (1) safety and feasibility similar to that of single-needle biopsy, and (2) an absence of serious adverse events defined as grade greater than or equal to three according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. RESULTS: A total of 30 percutaneous, transthoracic intratumoral biopsies and injections into the lung cancer were performed, two cycles (at d 0 and 7) received by each patient (311 biopsies and 96 intratumoral injections). All percutaneous cases achieved technical success with respect to needle placement for both biopsy and injection of CCL21 dendritic cells. Only minor complications were observed (grade <3), including pneumothorax (n = 10, 33%) and small postbiopsy hemorrhage (n = 2, 7%). Pneumothorax was moderate (n = 1) or trace (n = 9), with resolution of the moderate pneumothorax after manual aspiration without chest tube placement. No patient required chest tube placement. No other complications or serious adverse effects related to the biopsy or dendritic cell injection were noted. All patients were in stable condition after up to 4 hours in the recovery unit and were discharged home on the same day. No procedure-related complications were observed on imaging or clinical follow-up at 4 weeks. CONCLUSIONS: Repeated percutaneous, transthoracic CT-guided biopsies and intratumoral gene-modified cell-based immunotherapy injections into lung cancers are technically feasible, safe, and reproducible. There were no procedure-related serious (defined as grade ≥3) adverse events.
引言：评估在转移性非小细胞肺癌（NSCLC）中重复经皮计算机断层扫描（CT）引导下经胸活检及瘤内注射基因修饰树突状细胞的技术可行性和安全性。 方法：15例患有15个直径大于1.0 cm的NSCLC病灶的患者接受了两个周期的瘤内活检及CCL21树突状细胞注射，两个周期间隔7天。所有穿刺置针及注射均在CT引导下进行。首次操作后约4周进行临床及影像学随访。安全性和可行性的判定标准为：（1）安全性和可行性与单针活检相似；（2）根据美国国立癌症研究所不良事件通用术语标准第5.0版，无定义为大于或等于3级的严重不良事件。 结果：共进行了30次经皮经胸肺癌瘤内活检及注射，每位患者接受两个周期（第0天和第7天）（311次活检和96次瘤内注射）。所有经皮操作在活检及CCL21树突状细胞注射的穿刺置针方面均取得技术成功。仅观察到轻微并发症（<3级），包括气胸（n = 10，33%）和活检后少量出血（n = 2，7%）。气胸为中度（n = 1）或微量（n = 9），中度气胸经人工抽气后无需放置胸管即可缓解。无患者需要放置胸管。未观察到与活检或树突状细胞注射相关的其他并发症或严重不良反应。所有患者在恢复单元观察4小时后情况稳定，当天出院。4周时的影像学及临床随访未观察到与操作相关的并发症。 结论：在肺癌中重复经皮CT引导下经胸活检及瘤内基因修饰细胞免疫治疗注射在技术上是可行、安全且可重复的。未发生与操作相关的严重（定义为≥3级）不良事件。
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