4/22/2010 - It can be called the lung cancer paradox: A 65-year-old man has a small lung nodule, too small and difficult to locate without performing a thoracotomy — a major surgery with significant risk of complications.
Since the nodule is small, the doctors wait, conducting CT scans every six months looking for any changes. Nothing happens until the two-year mark when the nodule grows suddenly and significantly.
The surgery is performed and a biopsy reveals that lung cancer has spread to the lymph nodes. It happens all too frequently — too small to operate, too long to wait.
But Vanderbilt researchers in the Department of Thoracic Surgery are studying a new technique that may help solve part of this diagnosis dilemma.
Eric Grogan, M.D., M.P.H., was recently awarded a Specialized Program of Research Excellence (SPORE) pilot grant from the National Cancer Institute to determine if a new molecular compound, called DOTATE, can be used to more accurately find and remove small pulmonary nodules.
Grogan will lead the study that will test the accuracy of a long-lived radioisotope combined with the new compound to effectively “tag” small lung nodules. These tagged nodules could then be removed with minimally invasive thoracoscopic surgery. If effective, the technique offers promise for earlier diagnosis of lung cancer, as well as a reduction in the need for more invasive open thoracotomies, which place patients at greater risk for complications.
In their two-phase investigation, Grogan, Ron Walker, M.D., and their colleagues from Vanderbilt’s Department of Nuclear Medicine and the Nashville VA Medical Center hope to both bind to and tag previously hard to detect lung nodules, which are in some cases smaller than 1 centimeter in diameter. By applying a highly sensitive intraoperative gamma probe directly to the lung tissue, the team is optimistic the technique will produce significant and relevant results.
“If we can use minimally invasive surgical techniques to find and remove these tumors when they are small, then we have a chance to cure lung cancer,” said Grogan. “Otherwise, the cancer has the potential of spreading to the lymph nodes, where a cure is much less likely. That’s why research like this is so critical,” he said.
The statistics are alarming. More people die from lung cancer than any other type of cancer — more than breast, prostate and colon cancer combined. Its far reaching impact means that nearly one in 12 of men face the risk of developing lung cancer; one in 15 women. So, while early diagnosis is obviously critical, most small lung cancers are extremely difficult to treat.