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UW Carbone Cancer Center

He had been treated for cancer twice in the past five years. Both his head and neck cancer and his kidney cancer were in remission. When he recently was diagnosed with cancer again, this time in his lung, he was a poor candidate for the traditional treatment.


The patient, a man in his 60s, turned to the UW Carbone Cancer Center, a national leader in using innovative cancer treatments. It was good timing. UW Carbone Cancer Center is part of a research study using a relatively new video-assisted thoracic surgery procedure for high-risk lung cancer patients called VATS wedge resection with brachytherapy.


"He was an ideal candidate'' for the minimally invasive procedure, says Dr. Deepak Khuntia, a radiation oncologist and associate professor in the UW School of Medicine and Public Health's Department of Human Oncology. UW Carbone Cancer Center has been part of the research study since 2008.


The standard approach for addressing early lung tumors is to perform a lobectomy, the removal of an entire lobe of the lung. However, if a patient has poor lung function or significant co-morbidities, such as the previous cancers suffered by Khuntia's patient, it can be potentially hazardous.  


Those and other patients may be candidates for the VATS wedge resection procedure, which removes only a smaller piece of lung tissue. The surgery can be combined with brachytherapy, or radioactive seed implantation. UW Carbone Cancer Center was the first facility in Wisconsin to perform complete wedge resections with brachytherapy for high-risk patients with stage I non-small cell lung cancers smaller than three centimeters.


The ongoing clinical trial, ACOSOG 24032, randomizes patients to wedge resection alone or with brachytherapy. Dr. Khuntia says most patients opt to have the radiation done as part of the VATS wedge procedure since side effects are minimal.


Dr. Tracey Weigel - a professor and chief of thoracic surgery at UW Hospital and Clinics, and also a member of UW Carbone Cancer Center - performs the VATS wedge resection plus brachytherapy procedure with Khuntia after assessing the lymph nodes with a new technology that involves placing a tiny ultrasound probe (EBUS) down the airway. Under general anesthesia, the VATS procedure requires three small incisions (from 5 to 15 millimeters) in the patient's chest and side. The small incisions are used to insert surgical instruments during the procedure.


Using a 5-mm thoracoscope with video assistance, Weigel first removes a wedge-shaped section from the lung and the mediastinal lymph nodes. Khuntia then does the brachytherapy, which uses radioactive "seeds'' to treat an effectively much wider area of tissue. The seeds are sewn onto a mesh, which is folded over and attached to the exposed area where the wedge of lung tissue has been removed.


Recovery following the VATS procedure generally requires a hospital stay of one to two days, followed by a week of recovery at home. Patients can usually return to work within two weeks. This short recovery time is the first of two big advantages of the VATS procedure over the traditional open chest surgery, which requires a hospital stay of five to seven days plus a recovery period at home that can be up to a month or longer. The other advantage with the VATS wedge procedure is a lot less pain for the patient, because the ribs are not stretched.


UW has modeled its procedure after one done at the University of Pittsburgh Medical Center, which reports an average of 2 percent local recurrence (in the lung) with the brachytherapy versus about 20 percent with a wedge resection alone in its patients.


Khuntia states that the UW results are very comparable. "To date, we have had no local recurrence,'' he says.


And the patient? "He tolerated the surgery well,'' Khuntia says, adding that the patient's lung cancer is now in remission.