By David Tom Cooke, MD, as told to Susan Bernstein
The term is “inoperable lung cancer”. This means that the risk of surgery to remove lung cancer outweighs the benefits of surgery for a patient. However, it is difficult to tell if someone is “inoperable”.
Age is one factor that may slightly increase your risk, but it need not be prohibitive. I have operated on 90 year olds. Other health conditions you have may be a factor, such as impaired lung function. If we remove a lung tumor from someone who already has minimal lung function due to severe COPD or emphysema, that can make surgery risky, for example. There is a growing population of people who fit this description. To be determined that your lung cancer is “inoperable”, you really need to be seen by a thoracic surgeon.
The gold standard for treating early, inoperable lung cancer is something we call SBRT, or Stereotactic Body Radiation Therapy. It is high-dose focused radiation. SBRT is used to try to destroy the tumor. It’s very targeted, and we use special imaging to be very specific with this treatment, usually CT scans. It’s different from traditional high-dose radiation therapy to shrink or kill tumors. SBRT has the potential to cure lung cancer, but it’s unclear if it has the same cure rate for patients as surgery. We usually do one or two SBRT treatments and then you have routine follow-up for 5 years.
New experiments are underway in this area. It is thought 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 likelihood of killing and eliminating lung tumors. Checkpoint inhibitors activate one’s own immune system – to suppress “checkpoints” that slow down the immune system – to fight cancer.
Researchers are studying not only the effects of this combination therapy, but also how long patients should take these drugs. Currently, Phase I studies have been conducted to examine the safety of this SBRT/checkpoint inhibitor combination, along with ongoing clinical trials to examine the results of the combination therapy.
Another treatment used in the early stages is the use of [local scopes to treat the tumor], such as navigational bronchoscopy. For this treatment, we take a camera attached to the end of a catheter and insert it into the patient’s trachea or trachea. Then, either using high-tech guidance tools or combined with a CT scan, we direct the catheter to the tumor. It is also done with robotic technology combined with a scanner to guide the catheter to the tumor, followed by microwaves to kill the tumor or locally inject chemotherapy directly into the tumor. Animal studies are underway to test this type of technique.
There have been recent advances in surgery so that people whose lung cancer was once considered inoperable can become operable. A key factor here is robotic surgery. We can make smaller incisions for less stress on the body. Robotic surgery also allows us to remove less lung tissue to remove your tumour.
There are other new technologies on the horizon for the treatment of lung cancer. One may be a combination of robotic surgical technology with 3D imaging and heads-up displays in the operating room to carefully guide surgery. I always use this comparison: If your kid is going to prom, do you want them to go in a 1992 Ford Taurus or a 2022 Toyota Camry with all the latest safety innovations like corner assist dead bodies, airbags on all sides and a reversing camera? We can use these technologies to significantly increase safety during surgery.
There is another point which is important for the overview of lung cancer treatment. According to the American Lung Association’s 2021 “State of Lung Cancer” report, more than 20% of patients diagnosed with lung cancer have not received 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 receiving treatment for lung cancer, it’s best to discuss it with a team of doctors, including a thoracic surgeon, because we have so many different options to fight your disease.