Unique Treatment Combination Helps Clear Bronchioles of Tumors
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SUMMARY
Dr. Daniel Nader at CTCA at Southwestern Regional Medical Center (SRMC) has developed an innovative combination of treatments – high dose rate (HDR) brachytherapy together with intratumoral chemotherapy – to eradicate tumors that have grown in a patient’s bronchus.
Consider these facts: Lung cancer is the most common form of cancer. It is the leading cause of cancer death in both women and men worldwide, and it has surpassed breast cancer as the leading cause of cancer death in women.1 About 49 percent of patients diagnosed at a very early stage survive for five years or longer, while only two percent of people diagnosed with lung cancer that has spread to other areas of their body are living five years after the diagnosis.2
Now consider that of advanced stage non-small cell (NSC) lung cancer patients who were treated at a Cancer Treatment Centers of America® hospital between 2000 and 2005, about 37 percent were living one year after diagnosis compared to only about 21 percent of similar advanced stage NSC lung cancer patients represented in the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database.3
During the same time period, about 24 percent of CTCA patients with advanced NSC lung cancer were living 1.5 years after diagnosis as compared to only about 13 percent of similar patients represented in the SEER.
Unique Treatment Combination Helps Clear Bronchioles of Tumors
At CTCA at Southwestern Regional Medical Center (SRMC) in Tulsa, OK, Daniel Nader, DO, FCCP, a pulmonologist and director of the SRMC Lung Center, has developed an innovative combination of treatments – high dose rate (HDR) brachytherapy together with intratumoral chemotherapy – to eradicate tumors that have grown in a patient’s bronchus, which is one of the two large air tubes that lead from the trachea (windpipe) to the lungs.
In HDR brachytherapy, Dr. Nader places a thin plastic tube into the diseased bronchus during a bronchoscopy, and the tube is positioned next to the tumor. The bronchoscope is then removed and a very high dose of localized, internal radiation is delivered directly to the tumor through the portion of the tube resting against the tumor. “Lung brachytherapy not only treats the cancer from the inside out,” says Dr. Nader, “it also takes less time to complete a full course of treatment than traditional radiation therapy and it has fewer side effects.” The CTCA Lung Center in Tulsa has performed over 4,500 bronchoscopy procedures and provided well over 1,500 High-Dose Rate (HDR) brachytherapy treatments.
Dr. Nader took HDR brachytherapy technology to the next step when he began combining it with intratumoral chemotherapy, an advancement based on research reporting that chemotherapy makes tumors more sensitive to radiation. “We knew we were going to kill the tumor with radiation,” he said. “We wanted to make it a more precise kill. Until we developed this treatment, chemotherapy had not been used in combination with radiation and brachytherapy.”
In intratumoral chemotherapy, Dr. Nader injects the chemotherapy drug cisplatin directly into the tumor with a flexible, retractable needle placed through the bronchoscope. Intratumoral injection allows doctors to deliver cancer drugs to and within the tumor with great precision.With this treatment, the tumor is completely bathed in the drug. Doctors can use dramatically higher drug concentrations with this method as compared to systemic delivery. And, last, but definitely not least, some patients have virtually no side effects from the drug.
After the intratumoral chemotherapy treatment, patients receive weekly HDR brachytherapy for four weeks. In on-going clinical trials, led by Dr. Nader, this combination treatment cleared tumors out of the bronchioles of the patients, which, in turn, relieved their shortness of breath, coughing and respiratory infections. The trials also show that the tumors did not recur in the treated areas and that there were no adverse events or complications related to the treatment.4
“Our first 19 patients in the trial had complete clearing of their endobronchial disease,” says Dr. Nader, “and there were no complications related to the bronchoscopy, cisplatin or brachytherapy,”Dr. Nader says. “Follow-up at seven to 21 months with these patients revealed four deaths, all of which were the result of metastasis of the cancer to other parts of the body. There was no recurrence of endobronchial disease at the site of treatment in any of the patients.”
Dr. Nader reported initial results of the trial at a meeting of the American College of Chest Physicians held in Chicago in 2007. In 2009, he and his colleagues at SRMC published the results of another trial with 16 non-small cell lung cancer patients in the Journal of Clinical Oncology. Patients in this study suffered from lung obstructions that blocked more than 75 percent of a main airway. Following treatment, the obstruction was completely cleared in 14 of the patients. In the other two patients, dead tissue from the tumor – confirmed by laboratory analysis to be benign – remained in 10 to 20 percent of the airway.
“The results of this study demonstrate that intratumoral chemotherapy combined with HDR brachytherapy is a good option for many patients,” says Dr. Nader. “We are the only medical center in the US that uses this combination of therapies against non-small cell lung cancer. One reason is that this treatment requires three physicians plus support personnel to carry out, so it is very labor intensive. Second,many oncologists believe there isn’t much they can do for advanced stage lung cancer, so even though there are new treatments like these, their pessimism keeps them from trying.”
Yet, according to Dr. Nader,most patients who have the combination treatment feel much better afterwards. “Feeling better, having fewer side effects from the chemotherapy, and clearing the bronchus of disease also improve quality of life for the patients,” he says.
CTCA Lung Cancer Patients Report on Quality of Life
CTCA incorporates quality of life measurements into its routine clinical program.We track each patient’s ability to perform the basic activities of daily living.We ask how satisfied they are with their lives, and we evaluate their overall sense of well-being.The knowledge we gain enables our care teams to monitor and address specific cancer related symptoms such as fatigue, insomnia, and pain. CTCA assesses patient quality of life before and during their treatment. One study conducted at CTCA monitored the quality of life of 474 lung cancer patients who were treated at CTCA between January 2001 and December 2008.The results showed that during their first three months of treatment, these patients maintained their quality of life and experienced close to“normal” levels of physical health and levels of emotional well-being within the “normal” range.
CTCA invites each patient to participate in quality of life assessments both before and during treatment.We use the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30),which is one of the most reliable quality of life questionnaires in cancer research.
Clinical Trial Open to Certain Lung Cancer Patients
Dr.Daniel Nader,DO, FCCP, pulmonologist and director of the Lung Center at CTCA at Southwestern Regional Medical Center in Tulsa,OK, began a clinical trial in October 2005 to quantify the effects of HDR brachytherapy combined with intratumoral chemotherapy on certain late stage lung cancers.All patients in the on-going study had been diagnosed with non-small cell lung cancer and all of them suffered from tumors that formed inside the less-than-a-millimeter wide bronchioles, or airways, that lead to tiny air sacs where the lungs exchange oxygen.
“Before treatment, these patients were short of breath, they had severe coughs, and they often developed respiratory infections as a result of the bronchioles being blocked,” says Dr.Nader. “After treatment, the tumors had been cleared from the bronchioles, the patients’ symptoms were relieved, and the tumors did not recur in the treated sites.”
Dr.Nader continues to enroll patients in this clinical trial. If you have been diagnosed with late-stage non-small cell lung cancer in which a tumor or tumors have blocked bronchioles in your lungs, you may qualify for enrollment. Dr.Nader sees patients at SRMC in Tulsa to determine if they are candidates for the trial. Following his assessment, a CTCA review board approves his decision, oversees the trial and answers patient questions.
For further information about the clinical trial, contact a CTCA Oncology Information Specialist by calling 800-575-1255. More information about HDR brachytherapy and intratumoral chemotherapy is available online at www.cancercenter.com.
The Kind of Care Lung Cancer Patients Appreciate
While most hospitals strive for the highest levels of patient satisfaction, CTCA goes one step further. We want CTCA patients to be more than satisfied. We deliver such a high quality of care and treatment that most CTCA patients are willing to recommend us to their friends and loved ones.We call this patient loyalty.
To earn your loyalty,we do things most hospitals wouldn’t think of doing. For example, a patient recently suggested that a bench near the elevators would help tired patients during treatment. By that afternoon,we had a bench installed next to every elevator door in the hospital.
We do thoughtful things like this every day. Before you arrive, our representatives will handle every detail of your visit for you, including your transportation and lodging details.After you arrive and during your stay,we’ll ask you how we can make your experience better.We’ll do whatever is needed to improve – immediately. At CTCA we strive to provide a positive, stress-free, and hopeful environment for you and your loved ones so you can relax and focus on healing.
Because we listen to patients and understand what you value most,we can continue to improve the patient experience and treatment success.
1 http://www.emedicinehealth.com/lung_cancer/article_em.htm
2 Ibid.
3 Both the CTCA and SEER patients had been diagnosed with advanced stage non-small cell lung cancer at a similar time. CTCA patient results are based on a sample of 346 advanced-stage NSC
lung cancer patients.
4 D. Nader, et al, “Intratumoral chemotherapy as an adjunct to endobronchial brachytherapy.” Journal of Clinical Oncology 27:15s, 2009.
