Cancer Treatment Centers of America

What are some recent advancements in lung cancer treatment?

Answered by: Daniel Nader, DO, FCCP, FACP
Chief, Division of Pulmonary Services, Department of Medicine at Cancer Treatment Centers of America®; Chief of Staff, Lung Program Director, Director of Graduate Medical Education

In this explanation of innovative therapies, Dr. Nader talks about several treatment options, including intratumoral chemotherapy, brachytherapy, genomics and stereotactic radiation therapy

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Daniel A. Nader: Some of our new, upcoming innovative therapies that we’ve started and Cancer Treatment Centers of America is intratumoral chemotherapy. I mentioned brachytherapy. Brachytherapy is a form of radiation therapy, and one of the types of treatment that we’ve known for a long time is often times if we give some types of chemotherapy with the radiation, it makes the tumor more sensitive to the radiation therapy. So since we’re delivering focused radiation therapy to the tumor, we’ve decided to begin injecting some chemotherapy directly into the tumor inside the airways, and then using the brachytherapy as a secondary source of treatment. This allows the tumor to receive a sensitizing agent that will make the radiation therapy much more affective for the patient.

Our intratumoral chemotherapy project is a research project. We’re nearing completion in terms of patient enrollment, and we’re hoping that soon after that this will be a form of standard treatment for many of our patients receiving brachytherapy.

One of our other innovative treatments that we can provide is often times patients that have had surgery or have had other treatments or invasive procedures to the chest and often times end up with an air leak in their lung. And sometimes despite the best efforts of management, that air leak persists. This is especially true in some of our patients who have emphysema or other types of lung disease. Well we have a new technique and a new technology that allows us to actually place a little blocker agent called a spiration endobronchial valve. We can place this in the specific bronchial tube where the air leak exists, allowing the air leak to heal and then go back weeks later and remove that blocker device. This endobronchial valve device is relatively new, it’s undergoing major research right now for the management of emphysema. It’s utilization for this persistent air leak is relatively new and it’s been around for just a couple of years, and there are limited sights around the United States that are available to do this procedure.

Some of the other modalities that we have for treatment: you’ve heard of chemotherapy, radiation therapy, and surgery; but now chemotherapy is being dictated by the genomics. These are genetic testing that can be done of tumors, and that’s why it’s very important that we get a really good diagnosis. Often times patients that come have to have other biopsies done just so that we can do these genomic studies, because these genomic studies will dictate the type of chemotherapy that they receive, and it our medical oncologists know the genomics or genetic makeup of these individual tumors, it allows them to use very precise therapies for those individuals.

Part of the new technology that’s involved in radiation oncology is called stereotactic radiation therapy. What this technology involves is very localized but very high dose of radiation. The higher the dose that we can deliver, the better chance that we have of killing the tumor. However, we don’t want to deliver this high dose of therapy to healthy tissue, so using stereotactic techniques, we can localize that treatment just to the tumor without injuring healthy tissue. One of the ways that we’re able to do that is the use of fiducial markers. What fiducial markers are small, metallic objects that we can place in the lung, and here at Tulsa, how we do that, if we place them with the bronchoscope. This is a noninvasive way, with very little risk to the patient, so we don’t have risks of collapsing the lung or causing hemorrhage or other injury that can occur. As a result these markers then can be used to track the tumor while the patient’s getting radiation, so that the radiation delivery can be just to the tumor target, and not to other healthy tissue.

One of our other modalities in radiation therapy is what’s called high dose rate brachytherapy. Brachytherapy is not a new technique, it’s not a new procedure, the technology has definitely changed and as a result we’re able to deliver very high dose of radiation to a very limited small area. We use brachytherapy in lung cancer to treat cancers that are blocking the airways, that are blocking the bronchial tubes. And by doing so, we can open up those bronchial tubes, we can eliminate coughing of blood, we can open the airways so that the patients can breathe easier, have much less shortness of breath, help reduce their cough, and help reduce those obstructions of which pneumonia may be lurking behind.

Brachytherapy works by placing a small catheter through a bronchoscope into the patients’ bronchial tubes, where a lung cancer exists. When that catheter is placed there, then through that catheter will be placed a wire. Attached to the tip of the wire, about the size of a pencil lead, is a very high dose of radiation. That radiation then will be localized to exactly where that tumor is located. There it can treat that tumor with a high dose of radiation, and then automatically come out. There, the patient can get some relief, after several of these brachytherapy treatments, with regards to the obstruction of the airways by the tumor.