Changing the outlook for inoperable lung cancer

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By David Tom Cooke, MD, as stated by Susan Bernstein

The term is “inoperable lung cancer”. This means that the risk of having surgery to remove the lung cancer outweighs the benefit of the surgery to a patient. However, it’s hard to tell if someone is “inoperable.”

Age is a factor that can easily increase your risk, but it’s not necessarily prohibitive. I operated on 90-year-olds. Other health issues you have may be a factor such as B. a restricted lung function. For example, if we remove a lung tumor from a person who already has minimal lung function due to severe COPD or emphysema, it can make surgery risky. There is a growing number of people who fit this description. To determine that your lung cancer is “inoperable,” you really need to be seen by a thoracic surgeon.

The gold standard for treating inoperable early-stage lung cancer is something we call SBRT, or stereotactic body radiation therapy. It’s high-dose, focused radiation. SBRT attempts to destroy the tumor. It’s very targeted and we use special imaging to be very accurate with this treatment, typically CT scans. It differs from traditional high-dose radiation therapy to shrink or kill tumors. SBRT has the potential to cure lung cancer, but it is not known if it has the same cure rate for patients as surgery. We usually do one or two SBRT treatments and then you have a routine follow-up for 5 years.

There are some recent experiments in this area. It is believed that radiation can cause the release of antigens, small proteins that activate your immune system. There are studies to see if combining SBRT with immunotherapy drugs called checkpoint inhibitors can increase the chance of killing and eliminating lung tumors. Checkpoint inhibitors activate one’s immune system – to remove the “checkpoints” that slow down the immune system – in order to fight cancer.

The researchers are not only studying the effects of this combination therapy, but also how long patients would have to take these drugs. There are currently Phase I trials evaluating the safety of this SBRT/checkpoint inhibitor combination and ongoing clinical trials evaluating the outcomes of the combination therapy.

Another treatment used in the early stages is the use of [local scopes to treat the tumor]B. Navigation bronchoscopy. For this treatment, we take a camera attached to the end of a catheter and insert it into the patient’s windpipe or trachea. We then align the catheter to the tumor, either with the help of high-tech guidance tools or in combination with a CT scan. This is also done using robotic technology in combination with a CT scan to guide the catheter to the tumor, followed by microwaves to kill the tumor, or to inject chemotherapy locally directly into the tumor. Animal experiments are now being conducted to test this type of technique.

Recent advances in surgery have made it possible for people whose lung cancer was once thought to be inoperable to have surgery. A key factor here is robotic surgery. We can make smaller incisions to put less stress on the body. Robotic surgery also allows us to harvest less lung tissue to remove your tumor.

There are other new technologies for the treatment of lung cancer on the horizon. One can be a combination of robotic surgical technology with 3D imaging and heads-up displays in the operating room to carefully guide the operation. I always use this comparison: if your kid goes to prom, would you want them in a 1992 Ford Taurus or a 2022 Toyota Camry with all the latest safety innovations like Blind Spot Assist, airbags on all sides and a rear view camera? With these technologies, we can significantly increase safety during the operation.

There is one more point that is important to the overall picture of lung cancer treatment. According to the American Lung Association’s 2021 State of Lung Cancer report, over 20% of patients diagnosed with lung cancer did not receive any treatment. Additionally, black patients with lung cancer are 23% less likely to receive surgical treatment and 9% less likely to receive treatment compared to white patients.

Before undergoing any treatment for lung cancer, it is best to discuss this with a team of doctors, including a thoracic surgeon, as we have so many different options to combat your disease.



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