2007 Cancer Annual_prod5 - St. Joseph Medical Center

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Focus on Non-Small Cell Lung Cancer In-Depth Site Study (continued) in order to ensure that the best treatment strategy is applied. Patients with unrecognized mediastinal lymph node metastases who undergo major operations to remove their cancer are unlikely to be cured by their surgery. By identifying microscopic mediastinal lymph node involvement, mediastinoscopy can ensure that patients do not undergo major surgery that is unlikely to result in a cure. Instead, more appropriate treatment methods with a higher likelihood of success can be offered. Expanded Minimally Invasive Surgery Capabilities Patients with non-small cell lung cancer whose tumor has not yet spread beyond the lung have a significant chance to be cured by surgical removal of the tumor. While limited operations such as “wedge” resections can be curative, the likelihood of remaining free of disease is greater in patients who undergo complete removal of the entire lobe in which the cancer is located, using formal anatomic dissection. Increasingly, during the last 10 years, surgeons have used minimally invasive surgical techniques aided by slender telescopes and instruments in order to perform lung operations through very small incisions. These smaller incisions decrease the extent and duration of postoperative disability and allow an earlier return to normal functioning. In contrast, the standard surgical approach has involved making large incisions and spreading the ribs apart in order to gain access to the lung. Due to the added complexity of minimally invasive surgery techniques, surgeons who lack experience with these techniques are often restricted in the extent of surgical procedure they are capable of performing and may be limited to performing thoracoscopic “wedge” resections for lung cancer. However, at St. Joseph Medical Center, minimally invasive surgery techniques are now regularly used to perform procedures that most other centers are only able to offer using large incisions. The same anatomic dissection and surgical principles that would be used in open surgical procedures are always applied to minimally invasive procedures as well. Thoracoscopic lobectomy is routinely performed at St. Joseph Medical Center using meticulous individual dissection and ligation of anatomic structures through three, small thoracoscopy port sites, the largest of which typically measures less than two inches. Tri-Modality Therapy for Locally Advanced Lung Cancer The optimal treatment of lung cancer that has not spread to distant organ sites is surgical removal. Sometimes, however, the cancer has advanced locally to the point that complete surgical removal is not technically feasible. This is the case in stage III lung cancer. Recently, there has been increasing evidence that “triple modality” treatment with chemotherapy, radiation therapy and surgery results in greatly improved cure rates for locally advanced lung cancer. Due to the logistical complexity of coordinating patient care between three different specialists, and due to the technical challenges of performing surgery on such patients, most hospitals in the United States do not offer such sophisticated treatment. Tri-modality treatment of locally advanced lung cancer has been performed mainly in a limited number of large university centers. In a warm and caring Table 4 Comparative stage distribution of patients with non-small cell lung cancer Cancer St. Joseph Medical Center National Stage 2001– 2006 1996 – 2003 Localized 41% 16% Regional 17% 35% Distant 31% 42% Unstaged 11% 7% 12 | ST. JOSEPH MEDICAL CENTER sjmcmd.org
community setting, The Thoracic Oncology Center at St. Joseph Medical Center now has the necessary tools and expertise to provide even the most challenging locally advanced lung cancer cases with tri-modality treatment that is second-to-none. One example of stage III lung cancer that can benefit from triple modality treatment is disease that has spread locally to regional lymph nodes in the mediastinum. Another example of locally advanced lung cancer involves cancer arising at the top of the lung that has invaded the nerves and/or blood vessels of the arm. In these situations, surgical removal without any other treatment is very unlikely to be curative and the cancer usually recurs. Combined treatment with chemotherapy and radiation therapy is effective at decreasing the extent of the cancer and is better than surgery alone. Even with combined chemotherapy and radiation therapy, cure rates have remained rather low. However, locally advanced lung cancer that responds well to combined chemotherapy and radiation therapy can often be completely removed. The response of lung cancer to combined chemotherapy and radiation therapy is better in patients receiving relatively high doses of radiation therapy. Because radiation therapy results in inflammation and scar tissue formation, performing lung surgery on patients who have undergone such treatment is much more difficult than usual. The risk of complications can also be higher. For well over ten years, Drs. Krasna, Gamliel and Martin have been operating on lung cancer patients who have undergone combined chemotherapy and high-dose radiation therapy with enviably low complication rates, thus making it possible to implement the high standard of tri-modality treatment offered at The Thoracic Oncology Center. Improved Palliation Capabilities The goal of lung cancer treatment must not be limited to achieving a cure. For many patients whose lung cancer is not curable, relief of symptoms is essential. These patients may become short of breath for a variety of reasons. Most commonly, their shortness of breath is due to buildup of fluid in the chest cavity or due to airway obstruction by tumor. Obtaining rapid relief of their shortness of breath using minimally invasive methods can allow these patients to stay out of the hospital and regain quality of life. When advanced lung cancer results in fluid buildup in the chest cavity, the lung has less space for inflation. One-time drainage of the fluid provides only temporary relief, since the fluid will rapidly reaccumulate. One method for preventing fluid reaccumulation is to instill sterile powdered talc onto the lung using minimally invasive thoracoscopy through a tiny incision. The resulting inflammation causes the formation of adhesions between the lung and the rib cage, called pleurodesis, effectively obliterating the space where fluid might accumulate. In certain cases where the lung cannot reexpand due to a restricting rind of tumor, convenient long-term drainage can be achieved using an indwelling tunneled catheter. Patients are able to drain the fluid from their chest cavity at home by themselves as often as necessary, using convenient prepackaged sterile supplies. Often, after a couple of months of intermittent drainage at home, the fluid stops reaccumulating. Table 5 Number of patients with non-small cell lung cancer undergoing mediastinoscopy, surgical resection, neoadjuvant (preoperative) therapy and adjuvant (postoperative) therapy at St. Joseph Medical Center, by year. Year Mediastinoscopy Neoadjuvant Surgical Resection Adjuvant 2001 0 1 23 1 2002 5 0 24 4 2003 2 0 31 1 2004 1 1 32 0 2005 9 1 28 3 2006 7 2 28 2 2007 THE CANCER INSTITUTE ANNUAL REPORT | 13
Page 1 and 2: 2007 Annual Report | 2006 Statistic
Page 3 and 4: “This way, the patient is assured
Page 5 and 6: The Cancer Institute Cancer Liason
Page 7 and 8: Cancer Institute Registry Activity
Page 9 and 10: Focus on Non-Small Cell Lung Cancer
Page 11: Table 2 Geographic distribution of
Page 15 and 16: treat ever increasing numbers of pa

2007 Cancer Annual_prod5 - St. Joseph Medical Center

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