Novel approaches combining limited surgical resection and radiation therapy for lung cancer continue to evolve. Brachytherapy techniques are applicable in a subset of patients with non-small cell lung cancer and limited cardiopulmonary reserve who are not able to tolerate a lobectomy. Robotic surgical techniques now offer the ability to deliver precise brachytherapy through a minimally invasive surgical approach.
Using the da Vinci Surgical System and our previously reported research developed in animal models, two patients underwent robotic brachytherapy. A thoracoscopic wedge resection, followed by robotic intracorporeal suturing of I125 radiation seeds was performed in two patients. Patients had a tissue diagnosis prior to surgery and no evidence of metastatic disease. Patients were not candidates for lobectomy due to severe interstitial lung disease, decreased performance status, cardiac dysfunction, previous contralateral lobectomy and significant co-morbidities.
Patients underwent uncomplicated wedge resections of their primary tumor. Radiation seeds were sutured in place using one of two geometric configurations; longitudinal technique and spiral technique. The seed activity is designed to give a dose of 14,400 cGy at 1 cm from the plane of the implant. Radiation seed activity is delivered over nine months [5 half-lives]. There were no complications and post-operative courses were eventful.
The goal of therapy for patients with lung cancer who have significant risk factors and/or poor perfromance status is two-fold: 1. Complete resection of the primary lesion through a minimally invasive approach. 2. Deliver radiation that would achieve the highest tumoricidal dose with the least collateral damage to the surrounding lung parenchyma. Intracorporeal dexterity of the robotic system allows accurate and specific configurations of seed placement limiting excessive collateral damage to healthy tissue.
For selected patients with limited pulmonary reserve and significant comorbidities, tailored application of brachytherapy geometric patterns is now part of the treatment armentarium for high risk lung cancer patients. The use of robotic technology is now an integral part of the evolution in the treatment of lung cancer at our institution.
S.J. Belsley, None.