February 18, 2005

Increased lung function goal of new cancer therapy

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Joe Putnam Jr., M.D.

Increased lung function goal of new cancer therapy

Vanderbilt-Ingram Cancer Center is set to take part in a multi-center trial of a new lung cancer therapy that may help patients retain more lung function than traditional treatment methods. The new therapy involves removing only a small portion of a patient's lung and is combined with localized, short-acting radiation (brachytherapy).

“The trial is designed for patients with lung cancer who have problems with their breathing or their heart and who are not candidates for lobectomy,” said Joe B. Putnam Jr., M.D., Ingram Professor of Surgery and chair of the Department of Thoracic Surgery. Lobectomy removes an entire lobe of the lung, and may not be tolerated by those who have trouble breathing.

Although more lung tissue is lost, lobectomy has been traditionally used over a wedge-resection — which only removes a portion of the lobe — because it has lower cancer recurrence rates and higher survival odds. However, a new study reported at the annual meeting of the Society of Thoracic Surgeons suggests wedge-resection combined with brachytherapy has about the same local recurrence rate and survival rate as lobectomy.

Putnam, who chairs the Thoracic Organ Site Committee of the American College of Surgeons Oncology Group, said the goal is to test the treatment more broadly in a clinical setting. Vanderbilt-Ingram will be part of a national, multicenter clinical trial to test the lung-sparing procedure among patients at greater-than-average risk for lobectomy.

“We're really excited about the results from this first study and hope to confirm the procedure's effectiveness,” Putnam said. “The question of standard treatment with surgery versus minimal surgery with radiation is an interesting one, and it could change our standard of care for this patient group.”

Patients in the trial would have a surgical procedure to remove the tumor and a small amount of normal tissue around it.

The lung would then be treated with brachytherapy, wherein high-dose radiation is delivered through small, short-acting radiation beads implanted onto the surgical site.

In addition to evaluating rates of recurrence and survival, researchers will analyze blood and tissues for molecular characteristics that correlate with tumor recurrence.

The goal would be to develop protein profiles — a sort of molecular bar-code — that could eventually be used to predict recurrence risk and adjust treatment accordingly. The American College of Surgeons Oncology Group, a cooperative clinical trial group funded by the National Cancer Institute, will lead the trial that will include approximately 253 patients, about 30 of whom will be enrolled at Vanderbilt-Ingram.

The trial, which must be approved by each center's Institutional Review Board, is expected to begin in early summer.