Treatment Of Peripheral Lung Cancer Research Articles

Advanced navigation technology enables endobronchial brachytherapy for peripheral lung cancer: An old technique plays a new role

Background: To investigate the feasibility of super-selectively endobronchial brachytherapy in the treatment of peripheral lung cancer guided by advanced navigation technology. Patients and Methods: Six patients with peripheral lung tumors successfully underwent treatment with super-selectively endobronchial brachytherapy guided by advanced navigation technology following pathway planning, and were subsequently followed up to assess survival and treatment-related toxicities. Results: The endobronchial applicators were successfully placed inside the tumors of all patients using advanced navigation techniques according to the pre-treatment plan, and brachytherapy was delivered at curative doses after evaluation using radiotherapy planning software. None of the patients showed local progression of the treated lesions during the follow-up for a duration ranging from 11 months to 35 months, with a median follow-up time of 23 months. The patient with the longest follow-up, nearly 3 years, exhibited a stable condition. After undergoing endobronchial brachytherapy, patients predominantly experienced localized fibrosis as indicated. No significant alterations in cardiopulmonary function were detected during the follow-up, and no other adverse effects were found. Conclusion: The use of endobronchial brachytherapy for the curative treatment of peripheral lung cancers is feasible. Furthermore, the development of novel bronchial navigation techniques has the potential to broaden the application of endobronchial brachytherapy.

Microwave ablation via a flexible catheter for the treatment of nonsurgical peripheral lung cancer: A pilot study.

BackgroundEndobronchial microwave ablation via flexible catheter offers the potential for local therapy for inoperable peripheral lung cancer. The study aimed to evaluate the feasibility and safety of navigation bronchoscopy‐guided water‐cooled microwave ablation catheter for nonsurgical peripheral lung cancer.MethodsThis was a prospective single arm pilot study. Patients with early stage or multiple primary peripheral lung cancer who were nonsurgical candidates for surgery were enrolled in the study. Bronchoscopic microwave ablation was performed via a flexible water‐cooled microwave ablation antenna under the guidance of navigation bronchoscopy. Radial probe endobronchial ultrasound combined with fluoroscopy was used to confirm the position. Treatment outcomes were evaluated based on follow‐up chest CT and positron emission tomography scans. Primary endpoints were technical success and safety. Secondary endpoints were complete ablation rate, 2‐year local control rate, and progression‐free survival.ResultsThirteen patients were enrolled in the study from April 2018 to July 2019. A total of 19 sessions of microwave ablation were performed on 14 tumors under the guidance of navigation bronchoscopy. The technical success was 100%. Treatment‐related complications occurred in two patients. The complete ablation rate was 78.6% (11/14). The 2‐year local control rate was 71.4%. Median progression‐free survival was 33 months for all patients.ConclusionsIn this pilot study, bronchoscopic microwave ablation appears to be feasible with acceptable occurrence of complication in the treatment of peripheral lung cancer under the guidance of navigation bronchoscopy.

Transbronchial lung parenchyma cryoablation with a novel flexible cryoprobe in an in vivo porcine model

PurposeThe purpose of this study was to evaluate the feasibility and safety of transbronchial cryoablation with a novel flexible cryoprobe using nitrogen as the refrigerant in an in vivo porcine model of lung parenchyma. Materials and methodsA novel flexible cryoprobe using nitrogen as the refrigerant was used for transbronchial cryoablation of lung parenchyma in six normal female pigs. The cryoprobe was delivered to the distal bronchus in the bilateral porcine lungs via the bronchoscopic working channel under virtual bronchoscopy guidance. The position was confirmed with real-time computed tomography (CT). The whole procedure included two freeze-thaw cycles (15 min and 2 min, respectively). CT images were obtained during cryoablation and at 24 h, one week, two weeks and four weeks after the treatment to assess the effectiveness and safety of the procedure. Ablation zone tissue samples were obtained at 24 h and four weeks after the cryoablation for further histopathological analysis. ResultsAll ablation procedures (12/12; 100%) were performed successfully. No major complications occurred during the procedure or the observation period. The ablation zones were clearly depicted on CT with a maximal ablation zone volume at 24 h (21.88 ± 12.61 [SD] cm3) compared to 3.64 ± 2.06 (SD) cm3 and 10.73 ± 3.84 (SD) cm3 at the end of the 1st and 2nd freeze-thaw cycles, respectively (P < 0.001). Histopathological analysis revealed that a coagulative necrotic zone was formed along the target bronchus, with obvious vascular occlusion and hemorrhage 24 h after treatment. The lesions gradually formed fibrosis after four weeks. ConclusionThe novel flexible bronchoscopy-guided cryoablation is a feasible, safe and effective modality in an in vivo porcine model of peripheral normal lung parenchyma, suggesting potential capabilities for the treatment of peripheral lung cancer in humans.

Bronchoscopic treatment of peripheral lung cancer

早期肺癌的主流治疗方式是手术。然而，许多患者因各种原因无法手术而选择替代治疗。经支气管镜介入技术因其侵入性更小且有更多治疗方式的选择，成为可行的替代疗法。本文综述了支气管镜治疗周围型肺癌的几种主要的方法。.

A Novel Laser Fiberscope for Simultaneous Imaging and Phototherapy of Peripheral Lung Cancer

Phototherapy is an alternative treatment for patients with localized non-small cell lung cancer who are unable to undergo surgical resection. However, phototherapy is currently limited to treatment of centrally located lung cancer, with the much larger proportion of peripheral lesions remaining inaccessible. There are also concerns over the accuracy of targeted laser treatment because of the need to exchange visualization and irradiation fibers during therapy, preventing the operator from confirming the final location of the irradiation fiber. A newly developed parallel-type ultrasmall composite optical fiberscope (Laser-eYe Ultrathin fiberscope [LYU]), which enables simultaneous white-light imaging and phototherapy, was evaluated in preclinical lung cancer models. Three models were used: human lung cancer xenografts (A549) in mice, orthotopic VX2 lung tumors in rabbits, and exvivo pig lungs into which A549 tumor tissue was transplanted. A multifunctional porphyrin-phospholipid nanoparticle (porphysome) was used as a photosensitizer to evaluate fluorescence-guided photothermal therapy. The LYU's 0.97mm diameter and hydrophilic coating allowed easy passage through the working channel of all types of bronchoscopes and controlled guidance of the LYU tip in any desired direction. The LYU could visualize the peripheral bronchus and porphysome-laden peripheral tumors. The LYU could also perform photothermal therapy with simultaneous imaging. The LYU enables simultaneous imaging and phototherapy that allows accurate irradiation of peripheral lung cancers. This new laser device may enable ultraminimally invasive transbronchial treatment of peripheral lung cancer.

Hypofractionated 192Ir source stereotactic ablative brachytherapy with coplanar template assistance in the primary treatment of peripheral lung cancer.

PurposeIn this study, we reported the safety and efficacy of hypofractionated 192Ir source stereotactic ablative brachytherapy (SABT) with coplanar template assistance for peripheral lung cancer, and compared the dosimetric parameters between SABT and stereotactic body radiotherapy (SBRT).Material and methodsThirty-three peripheral lung cancer patients, with the gross lung tumor volume (GTVL) < 5 cm in diameter were enrolled in this study. We assessed the safety and efficacy of SABT, and compared the dosimetric parameters between SABT and SBRT.ResultsChest computed tomography (CT) of post-SABT revealed mild pneumothorax in 2 of 33 patients. Complete response (CR) plus partial response (PR) rate for GTVL at 6-month was 100%. Local control (LC) rate for GTVL at 1-year was 96.9%. For organs at risk (OARs), D1000 cm3, and D1500 cm3 for lung in 1, 3, and 5 fractions were not statistically different between SABT and SBRT (all p > 0.05); the remaining dosimetric parameters were significantly lower in SABT than in SBRT (all p < 0.01).ConclusionsSABT can provide safe and effective treatment, and warrant generalization for peripheral lung cancer.

Application of Coplanar Template in the Treatment of Peripheral Lung Cancer by 192Ir Brachytherapy and Related Factors of Adsorbed Dose of the Lung

Application of Coplanar Template in the Treatment of Peripheral Lung Cancer by 192Ir Brachytherapy and Related Factors of Adsorbed Dose of the Lung

Efficacy comparison of single utility port and multiple utility ports thoracoscopic lobectomy for peripheral lung cancer

Objective To compare the clinical efficacy of single utility port and multiple utility ports thoracoscopic lobectomy in the treatment of peripheral lung cancer, and to study the operation skills, relative merit and feasibility of the single utility port thoracoscopic lobectomy. Methods The clinical data was analyzed retrospectively for 223 cases with stageⅠ orⅡ of peripheral lung cancer who underwent thoracoscopic lobectomy from July 2011 to November 2014 in Shanxi Provincial Cancer Hospital. Among 223 cases, 78 cases received single utility port thoracoscopic lobectomy (single utility port group), 145 cases received 2 or 3 utility ports thoracoscopic lobectomy (multiple utility ports group). The clinical outcomes involved time of operation, intraoperative blood loss,chest drainage, postoperative hospital stay, stations of lymph node dissection, numbers of lymph node dissection, rate of turn to open, postoperative complications, 2-year survival rate and disease free survival rate. Results No perioperative death occurred in both groups. There was no statistical difference between single utility port group and multiple utility ports group in operation time [(157.4±13.6) min vs. (151.3±23.2) min], intraoperative blood loss [(180.77±59.97) ml vs. (171.31±77.51) ml],chest drainage [(370.26± 146.09) ml vs. (351.17±159.07) ml], lymph node dissection stations (4.29±0.65 vs. 4.21±0.73), lymph node dissection number (11.50±2.30 vs. 11.04±2.29), rate of turn to open [(5.13% (4/78) vs. 4.83% (7/145)], incidence of postoperative complications [17.95% (14/78) vs. 15.86% (23/145)], postoperative hospital stay [(8.74±0.51) d vs. (9.48±0.63) d], 2-year survival rate [96.15% (75/78) vs. 93.79% (136/145)] and 2-year disease free survival rate [80.77% (63/78) vs. 82.07% (119/145)] (all P > 0.05). Conclusions The single utility port thoracoscopic lobectomy could achieve the same clinical results as the multiple utility ports. The single utility port thoracoscopic lobectomy is a safe, effective and feasible surgical procedure. Key words: Lung neoplasms; Thoracic surgical procedures; Thoracoscope; Single utility port

A novel IMRT planning study by using the fixed-jaw method in the treatment of peripheral lung cancer with mediastinal lymph node metastasis

Intensity-modulated radiotherapy (IMRT) is an important technology in cancer radiotherapy. In the current planning system, such as in the Pinnacle3 system, jaw positions are automatically set to cover all target volumes, and many medical centers in developing countries are not equipped with linear accelerators with a jaw tracing function. As solitary lesions are often located in patients, the resulting radiation leakage and transmission increase the dose exposure in surrounding critical organs, although blocked by multileaf collimator (MLC) leaves. We therefore designed a method to manually fix jaw positions, which further reduces doses. We particularly focused on the patients of peripheral lung cancer combined with mediastinal lymph node metastasis, as our medical center mainly targets lung cancer. We designed 2 treatment plans for each patient with the same optimization parameters, i.e., the plan of automatically chosen jaw positions (jaw auto-chosen plan) and the plan of fixed-jaw positions (fixed-jaw plan). In the latter plan, jaws were manually fixed for tumors in lung and in mediastinal lymph node metastases, respectively. We found that both plans met the clinical requirements, and the D2, D98, conformation number (CN), and homogeneity index (HI) for planning target volume (PTV) had no significant differences between the 2 plans. Importantly, the machine units (MUs) for fixed-jaw plans were 50%~60% more than routine jaw auto-chosen plans, whereas the V5, V10, V20, V30, and the mean dose in the total lung and the ipsilateral lung were less than the routine jaw auto-chosen plans. Dose-volume values D1 for the spinal cord and D2, V40, V60 for the heart existed no significant differences for 2 plans. In the fixed-jaw method, the total lung TLV5-△Vab and TLV10-△Vab values had a moderate positive correlation with the lung radiation leakage and the transmission area reduction. We concluded that the fixed-jaw plan is superior to the routine jaw auto-chosen plan in reducing the radiation exposure of surrounding critical organs, which will benefit the IMRT application.

Clinical analysis of thoracoscopic lobectomy in the treatment of peripheral lung cancer with single utility port

背景与目的胸腔镜肺叶切除术在肺癌治疗领域的价值与可行性已被广泛接受。本研究探讨单操作孔肺叶切除术治疗周围型肺癌的临床效果。方法回顾性分析2011年2月-2013年1月苏州大学附属第一医院心胸外科经单操作孔胸腔镜肺叶切除术治疗的周围型肺癌患者87例（单操作孔组），用同期经传统“三孔法”肺叶切除术治疗的周围型肺癌作为对照（“三孔法”组）。比较两组患者的手术时间、术后下床活动时间及住院时间、术中出血量、术后总引流量、术后拔管时间、清扫淋巴结数量及术后并发症、术后疼痛的发生情况。结果两组患者手术过程顺利，单操作孔组与三孔法组手术时间（151.03±25.97）min vs (156.27±26.49）min、淋巴结清扫数目（13.06±1.36）枚vs（12.61±1.56）枚、术中出血量（188.62±47.03）mL vs（179.60±28.96）mL及术后并发症发生率（18/87）vs（21/75）差异无统计学意义（P > 0.05)；术后下床活动时间（11.17±8.69）vs（13.76±7.43）h、术后住院天数（7.18±1.95）天vs（7.92±2.03）天、拔除引流管时间（3.85±1.21）天vs（4.43±1.43）天及总引流量（671.49±178.31）mL vs（736.93±170.39）mL的差异有统计学意义（P < 0.05），两组患者术后视觉模拟评分法（vision analogue score, VAS）评分变化差异有统计学意义（P < 0.01）。结论单操作孔肺叶切除术治疗周围型肺癌可以达到与传统“三孔法”全腔镜肺叶切除术相同的效果，是一种有发展前途的手术方式。

Clinical experiences with 20 cases of single-direction thoracoscopic lobectomy and systematic lymph node dissection for peripheral NSCLC

ObjectiveTo evaluate the safety, efficacy, feasibility of single-direction thoracoscopic lobectomy for peripheral lung cancer. MethodsFrom December 2009 to March 2011, 20 patients with peripheral lung cancer were treated with single-direction thoracoscopic lobectomy and systemic lymph nodes dissection. ResultsSurgeries were successfully performed. No significant complications occurred perioperatively. The average operation time was 193 min, the average blood loss was 234 ml, the average duration of drainage was 6 d, the postoperative hospital stay was 12 d, and the average number of lymph nodes dissected was 16. ConclusionSingle-direction thoracoscopic lobectomy is feasible and safe in the treatment of peripheral lung cancer and can simplify the surgical procedures.

Diagnosis and treatment of small peripheral lung cancer

周围型小肺癌的构成比约占同期肺癌的10%左右.经手术切除5年生存率超过80%.Noguchi组织学分型的A型和B型在胸部CT上常常表现为磨玻璃影(GGO),5年生存率可达97.3%.即使是≤2 cm的病灶,仍可伴有10%～30%的淋巴结转移.标准的治疗方法应为肺叶切除加系统纵隔淋巴结清除.除非病灶≤1 cm且在胸部薄层高分辨CT上显示明显的GGO,则可考虑行病灶局部切除。

Ultrasonography-guided percutaneous microwave ablation of peripheral lung cancer

The aim of this study was to evaluate the feasibility and therapeutic effectiveness of ultrasonography (US)-guided percutaneous microwave ablation (PMA) in the treatment of peripheral lung cancer. From December 2002 to September 2003, 12 Chinese patients with 16 histologically proven lung malignant tumors (6 primary and 10 metastatic) were treated with US-guided PMA. All tumors were located at the peripheral portions of the lung where the tumors were in direct contact with visceral pleura and visualized on US. A total of 21 insertions with 25 applications was administered to the 16 tumors. There was no radiation or chemotherapy combined with PMA. Based on the follow-up period of 6-40 months (average=20 months), seven patients survived without serious complications and five patients died from metastasis after PMA. The size of treated tumors was decreased in all cases (10 tumors with moderate to remarkable area reduction and 6 tumors with mild area reduction). Blood flow in the tumors became either invisible or diminished on color Doppler flow imaging, which showed 9 tumors with no enhancement and 7 tumors with partially decreased enhancement on contrast-enhanced computed tomography after PMA. All patients experienced improvement of clinical symptoms after PMA treatment. Ultrasonography-guided PMA, a mildly invasive procedure, is an effective, safe, and feasible method for treating peripheral lung tumors. Percutaneous microwave ablation provides an alternative therapy for patients with inoperable peripheral lung cancer as well as for patients who refuse radiation or chemotherapy.

2463: US-guided percutaneous microwave ablation of peripheral lung cancer

Objectives: The aim of this study was to evaluate the feasibility and therapeutical effectiveness of ultrasonography (US)-guided percutaneous microwave ablation (PMA) in the treatment of peripheral lung cancer.