title: Treatment of isolated mediastinal and hilar recurrence of lung cancer with bronchoscopic endobronchial ultrasound guided intratumoral injection of chemotherapy with cisplatin.
abstract: OBJECTIVE
  A common pattern of recurrence in lung cancer after receiving full dose external beam radiation therapy (EBRT) to targeted sites is isolated mediastinal and hilar recurrence (IMHR). Treatment options for these patients are limited to palliative radiation, chemotherapy, and/or best supportive care. We describe our experience with treating IMHR with bronchoscopic endobronchial ultrasound (EBUS) guided intratumoral injection of cisplatin (ITC).
  
  
  METHODS
  Patients treated between Jan 2009-September 2014 with ITC for IMHR were included. Patient demographics, tumor histology, size, concurrent therapy, location, number of sites treated, treatment sessions, and encounters were abstracted. Responses were analyzed on follow-up scans 8-12 weeks after the last treatment session using RECIST 1.1 criteria. Locoregional recurrence, progression-free survival (PFS), and overall survival were measured.
  
  
  RESULTS
  50 sites were treated in 36 patients (19 males, 17 females) with mean age 61.9±8.5 years. Eight sites treated on subsequent encounters were excluded and one patient had an unevaluable response, leaving 35 patients and 41 sites for final analysis. 24/35 (69%) had complete or partial response (responders), whereas 11/35 (31%) had stable or progressive disease (non-responders). There were no significant differences in response based on histology, size, and concurrent therapy. Median survival for the group was 8 months (95% CI of 6-11 mo). Responders had significantly higher survival and PFS than non-responders. Two patients treated with concurrent EBRT, developed broncho-mediastinal fistula.
  
  
  CONCLUSIONS
  EBUS guided intratumoral cisplatin for IMHR appears to be safe and effective, and may represent a new treatment paradigm for this patient population.
authors.affiliation: Division of Pulmonary, Critical care, Sleep Medicine, University of Florida, College of Medicine, United States. Electronic address: Hiren.Mehta@medicine.ufl.edu.
authors.forename: Hiren J
authors.initials: HJ
authors.lastname: Mehta
authors.affiliation: Division of Pulmonary, Critical care, Sleep Medicine, University of Minnesota College of Medicine, United States.
authors.forename: Abbie
authors.initials: A
authors.lastname: Begnaud
authors.affiliation: Division of Pulmonary, Critical care, Sleep Medicine, University of Florida, College of Medicine, United States.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Penley
authors.affiliation: Division of Pulmonary, Critical care, Sleep Medicine, University of Florida, College of Medicine, United States.
authors.forename: John
authors.initials: J
authors.lastname: Wynne
authors.affiliation: Division of Pulmonary, Critical care, West Virginia University Charleston Division, United States.
authors.forename: Paras
authors.initials: P
authors.lastname: Malhotra
authors.affiliation: Interventional Pulmonology, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Fernandez-Bussy
authors.affiliation: UF Health Shands Hospital, Department of Pharmacy, Gainesville, FL, United States.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Cope
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, University of Florida, United States.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Shuster
authors.affiliation: Division of Pulmonary, Critical care, Sleep Medicine, University of Florida, College of Medicine, United States.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Jantz
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002945:Cisplatin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional / Q000379:methods*; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Lung cancer recurrence; Sisplatin; endobronchial ultrasound