The Royal Marsden NHS Foundation Trust, Fulham Road, London, UK.
St George's NHS foundation trust, London, UK.
Cancer Imaging. 2024 Oct 25;24(1):145. doi: 10.1186/s40644-024-00763-y.
Directly-injected therapies (DIT) include a broad range of agents within a developing research field in cancer immunotherapy, with encouraging clinical trial results in various tumour subtypes. Currently, the majority of such therapies are only available within clinical trials; however, more recently, talimogene laherparepvec (T-VEC, Imlygic) has been approved as the first oncolytic virus therapy in the USA and Europe. Our institution contributes to multiple different trials exploring the efficacy of DIT, the majority of which are performed by oncologists in clinic. However, specific, challenging cases - mainly neck tumours - require image-guided administration.
This review article addresses the technical and logistical factors relevant to the incorporation of image-guided DIT into an established ultrasound service. Image-guidance (usually with ultrasound) is frequently needed for certain targets that cannot be palpated or are in high-risk locations, e.g. adjacent to blood vessels. A multi-disciplinary approach is essential to facilitate a safe and efficient service, including careful case-selection. Certain protocols and guidance need to be followed when incorporating such a service into an established ultrasound practice to enhance efficiency and optimise safety. Key learning points are drawn from the literature and from our early experience at a tertiary cancer centre following image guided DIT for an initial cohort of 22 patients (including 11 with a neck mass), addressing trial protocols, pre-procedure work-up, organisation, planning, consent, technical aspects, procedure tolerability, technical success, and post-procedure considerations.
With appropriate planning and coordination, and application of the learning points discussed herein, image-guided administration of DIT can be safely and efficiently incorporated into an established procedural ultrasound list. This has relevance to cancer centres, radiology departments, individual radiologists, and other team members with a future role in meeting the emerging need for these procedures. This paper provides advice on developing such an imaging service, and offers certain insights into the evolving remit of radiologists within cancer care in the near future.
直接注射疗法（DIT）包括癌症免疫疗法中一个不断发展的研究领域中的广泛的药物，在各种肿瘤亚型的临床试验中取得了令人鼓舞的结果。目前，大多数此类疗法仅在临床试验中可用；然而，最近，talimogene laherparepvec（T-VEC，Imlygic）已被批准为美国和欧洲的第一种溶瘤病毒疗法。我们的机构参与了多项不同的临床试验，以探索 DIT 的疗效，其中大多数由临床肿瘤学家进行。然而，特定的、具有挑战性的病例——主要是颈部肿瘤——需要影像学引导下给药。
本文讨论了将影像学引导下 DIT 纳入成熟的超声服务中所涉及的技术和后勤因素。对于某些无法触及或位于高风险位置的目标，如靠近血管的目标，通常需要影像学引导（通常是超声）。为了促进安全、高效的服务，包括仔细选择病例，需要采取多学科方法。在将此类服务纳入成熟的超声实践中时，需要遵循某些方案和指导原则，以提高效率并优化安全性。从文献和我们在一家三级癌症中心的早期经验中，我们总结了一些关键的学习要点，这些经验涉及到 22 名患者（包括 11 名颈部肿块患者）的初始队列的影像学引导下 DIT，包括试验方案、术前检查、组织、计划、同意、技术方面、程序耐受性、技术成功和术后考虑。
通过适当的规划和协调，以及应用本文讨论的学习要点，可以安全、高效地将影像学引导下 DIT 纳入成熟的程序性超声列表中。这对于癌症中心、放射科部门、个别放射科医生以及未来在满足这些程序的新兴需求方面发挥作用的其他团队成员具有重要意义。本文提供了关于开发此类成像服务的建议，并为未来放射科医生在癌症护理中的作用提供了一些见解。
