My name is Dr. Eric Anderson. I am Director of interventional pulmonary
here at Georgetown University Hospital.
My job entails the diagnosis and staging of lung cancer for patients who might be
at risk for lung cancer, we screen patients for patients who had been newly
diagnosed with a lung nodule. We help to find out what the cause is
and once you have been diagnosed lung cancer we do the important staging of the patient
to find out if any lymph nodes are involved in the chest.
Once you have been diagnosed with lung cancer my job also entails helping to
treat it with different modalities with radiation and treatments for endobronchial
tumors, tumors that are inside the airways. At Georgetown we have all the pieces of
the puzzle for taking care of you if you have lung cancer.
We have seen changes from improvements in lung cancer screening with a survival benefit.
We now have technologies available to us to do a biopsy and stage of patient in
a less invasive way and now we have even better ways to treat patients that don't
cause pain or discomfort and potentially even cure the patient.
For a patient with early stage lung cancer now it is great joy to watch their
tumors disappear after treating them with CyberKnife and having those symptoms from
the treatment. It is a very exciting time for lung
cancer and we hope these advances will start leading to a better outcome for our
patients and a better survival rate long term.
How do you use CyberKnife to treat lung?
Very exciting news has come out these past few years with our results from treatment
of lung cancer with CyberKnife.
CyberKnife is a type of focused radiation and it takes many beams that are the size
of pencils and aims radiation directly at the patient from on average for a lung
cancer 150 different direction. This is different than conventional
radiation whether radiation is aimed from front to back and is given to patients
over 6 weeks. CyberKnife radiation involves a beam
directed from a robot arm for many different directions and we give patients
5 treatments over 1 week and then finish the treatment.
Because it is so short a course of time and because it is so highly focused we can
limit damage to surrounding tissues
and provide a very high dose of radiation to the treated tumor.
What is involved in getting CyberKnife treatment for lung cancer?
The first thing we need to do to treat somebody with CyberKnife is place small
gold seeds in or around the tumor. These seeds are used by the CyberKnife
machine to localize the tumor when you are in the treatment room beams will be
directed at the target and the only way that machine can see this is by taking
x-rays through the x-rays will line up the gold seeds that we place and allow us to
more accurately pinpoint the target that we are treating.
To place these gold seeds we do it by either bronchoscopy or CAT scan guidance
for a small tumor along the periphery of the lung we can do that with a CAT scan
which involves a similar procedure to a biopsy and needles placed through a side
of the chest wall and a biopsy is taken if the patient has not had the diagnosis yet
and at the same time a needle is used to place the gold seeds.
If we do it by bronchoscopy for more central tumors, tumors along the airway or
along the middle portions of a lungs we
can put the patient under anesthesia and do a bronchoscopy, a small camera that
is fed down through the airways which is painless. We allow to guide it into the periphery
of the lung. And then use a small needle to insert the
gold from the inside of the airway into the target or around the target.
Once the gold seeds have been in placed the patient waits about 1 week before
having it planting CAT scan done in the CyberKnife suite.
The doctors will then use that information to do the plan for the
treatment which then begins usually the next week.
How many CyberKnife treatments will I probably need and how long will they take?
Treatments will be 3 to 5 treatments each lasting about 1-1/2 hours long with the
patient lying on the table watching the machine move about them aiming the treatments.
How will I feel after my CyberKnife treatment for lung cancer?
The treatments are painless and are very well tolerated by the patients.
When we ask them if they have side effects the main side effect has been fatigue.
If a tumor is located immediately adjacent to the surface of the lung it
is possible that they could have some discomfort most patients are relieved by
Tylenol or ibuprofen everyone else who has tumors in the central areas are not
expected to have significant side effects from this treatment.
Who is the ideal lung cancer patient to receive CyberKife treatment?
The ideal patient with a lung cancer
is someone who has a small early stage lung cancer who is inoperable.
A patient may have significant emphysema or heart disease and not have an option
for surgical resection.
In these patients the CyberKnife is ideal. The tumor is small and we can eliminate
it with a very high chance of success of curing the patient from the cancer.
When the patient has lymph nodes that are spread to other places then it is no
longer a good candidate for this treatment. If I have already had conventional
radiation for my lung cancer can I still receive CyberKnife treatment for this cancer?
Other patients who may benefit from the CyberKnife for treatment of lung tumors
include patients who have been previously radiated. These patients have had conventional
radiation to the middle of the chest but may still have an option for giving
additional boost of radiation to treat a single area that may become a problem.
In addition patients who have cancer that is traditionally insensitive to
chemotherapy or radiation may be a benefit for a single treatment of a cyber knife.
Patients with melanoma or sarcomas or kidney cancers usually do not respond to
radiation, but because we get a very high dose of radiation in a short period of
time we can give a good response to tumors that have traditionally not responded well
to conventional radiation. Can CyberKnife be used to treat other
cancers that have spread to the lung? The CyberKnife can be used to treat
metastatic disease that has spread to the lung including tumors that are less
sensitive to conventional radiation. Tumor such as kidney cancer and sarcomas
and melanomas may respond to the CyberKnife when they don't respond to
conventional radiation. So if your tumor has spread to the lung
and has a single place which has become a problem this may be a good option for you.
What have been your results with treating lung cancer patients with the CyberKnife?
At Georgetown we have been treating patients with lung cancer with CyberKnife
since2004.
We have treated more patients in the world with the CyberKnife for lung cancer
than any other center. Our results are looking very good for
patients who have stage I, early stage lung cancer at 4-1/2 years of follow up on
these patients we have a survival that is comparable to surgical resection with
a very good local control rate of over 85% and a 5 year survival of at least 70%
and our early survivors. Why should I come to Georgetown to be
treated with the CyberKnife for lung cancer? You should come to Georgetown for your
treatment because we have the most experience with treating lung cancer than
any other center in the world.
We have treated more patients since 2004 with lung cancer than any other center.
Our team is very experienced and we had exceptional results for patients with
early stage lung cancer and good results for patients who have had recurrent
cancers that needed focal therapies to help them.
What new technologies does Georgetown University Hospital have for diagnosing
lung cancer? There are many new advances in technology
for the diagnosis and staging of lung cancer and we are very lucky here at
Georgetown to have many of these available to us.
The most recent additions have been endobronchial ultrasound and super
dimension electromagnetic navigational bronchoscopy.
How does endobronchial ultrasound or EBUS work? The endobronchial ultrasound is an
important tool for staging patients who have been diagnosed with lung cancer.
This involves a flexible bronchoscopy with a camera placed down the airway
and at the end of the bronchoscope is a small ultrasound probe that allows us to see on
the other side of the mucosa that allows us to see the lymp nodes in real time
and place a needle directly into the lymph node with real time visualization so we
can see that we are sampling the lymph node. This has led to an increase in our yield
for diagnosis for the lymph nodes in the middle of the chest.
Importantly if you have been diagnosed with lung cancer we need to know where it
has spread to and which lymph nodes are involved. This technology is minimally invasive as
an outpatient procedure and as a high yield of diagnosis when coupled with the
use of endoscopic ultrasound biopsies we now can stage the mediastinum with
cameras and small scopes and no longer
need to use surgery to find out if the patient has spread other cancer to the
middle of the chest. What is superDimension technology and how
does it work to diagnose lung cancer?
superDimension is an electromagnetic navigational bronchoscopy.
It is like doing a GPS system for your lung instead of for your car.
It allows me to guide a bronchoscope out to the periphery of the lung in a more
accurate fashion so we can find and diagnose small lung tumors or lung nodules.
The advantage of this over conventional bronchoscopy is that it is not limited by
the large airways where the scope can go no further.
We have a small tool that is able to be placed beyond the smaller airways
and tracked using electromagnetic navigational field around the patient.
This allows me to use the virtual images generated from a CAT scan to guide a probe
into the periphery of the lung and when we get close to it with better accuracy we
can now biopsy and place fiducials for CyberKnife or perhaps even
treat lung cancers with other modalities through the bronchoscope.
What is the benefit to using superDimension for a lung biopsy over
traditional CT - guided biopsy? Traditionally CAT scan guidance was the
only way that we could reach these small nodules accurately and the risk with doing
a CAT scan guided biopsy that can potentially collapse your lung in about
25% of the time is also a risk of causing hemoptysis or coughing up blood as
a result of a CT guided needle biopsy. With bronchoscopy done through the airway
and doing biopsies with superDimension that risk of collapse of lung has been
reduced to less than 1% and the risk of bleeding is only 1 or 2% as well.
In addition we have a more accurate biopsy performed these nodules.
In the past with bronchoscopy a small nodule could only be biopsied and
a diagnosis in 25% at a time, but with this system we have been able to increase it to
at least 70%. Who can be considered for superDimension
for a lung biopsy?
A good candidate for superDimension is a patient who has been found to have a small
lung nodule. A nodule that is traditionally harder to
get by conventional bronchoscopy maybe further out in the periphery but as long
as there is an airway that can be seen leading in to this on your CAT scan you
may be an excellent candidate for this kind of biopsy and then maybe a safer way
of getting a diagnosis than the previously used CAT scan guided biopsy.