Changing outlook for inoperable lung cancer

By David Tom Cook, MD, as told to Susan Bernstein

The term is “inoperable lung cancer.” This means that the risks of surgery to remove lung cancer outweigh the benefits of surgery for the patient. However, it is difficult to tell if someone is “incompetent”.

Age is one factor that can slightly increase your risk, but it is not necessarily a contraindication. I have operated on 90 year olds. Other health problems you have could be a factor, such as poor lung function. If we remove a lung tumor in someone who already has minimal lung function due to severe COPD or emphysema, that could make surgery too risky, for example. There is an increasing number of people who fit this description. In order to be sure that your lung cancer is “inoperable,” you really need to be seen by a thoracic surgeon.

The gold standard for treating early, inoperable lung cancer is something we call SBRT, or stereotactic body radiotherapy. It is a high dose of focused radiation. SBRT is used to try to destroy the tumor. It’s very targeted, and we use special imaging to be very accurate with this treatment, usually a CT scan. Conventional radiation therapy varies with high doses to shrink or kill tumors. SBRT has the potential to treat lung cancer, but it is not known if it has the same cure rate for patients as surgery. We usually do one or two SBRT sessions, and then you have a routine follow-up for about 5 years.

Another treatment used in the early stages is the use of [local scopes to treat the tumor], such as navigational bronchoscopy. In this treatment, we take a camera attached to the end of the catheter and insert it into the patient’s trachea or trachea. Then, either using high-tech guiding tools or in combination with computed tomography, we guide the catheter toward the tumor. This is also done using robotic technology in combination with CT scans to guide catheters into the tumor, followed by microwaves to kill the tumor, or to inject chemotherapy locally directly into the tumor. There are animal studies being done now to test this type of technique.

There have been recent advances in surgery, so people whose lung cancer was previously considered inoperable may now become operable. One of the main factors here is robotic surgery. We can make smaller incisions to reduce pressure on the body. Robotic surgery also allows us to take less lung tissue to remove the tumor.

There are other new technologies on the horizon for treating lung cancer. One might be a combination of robotic surgical technology with 3D imaging and head-up displays in the operating room to carefully guide surgery. I always use this comparison: If your kid is going to prom, would you want him to go in a 1992 Ford Taurus or a 2022 Toyota Camry with the latest safety innovations, like blind spot assist, all-around airbags, and a backup camera? We can use these techniques to greatly increase safety during surgery.

There is another important point for the big picture of lung cancer treatment. According to the American Society for Disease Control’s 2021 “State of Lung Cancer” report, more than 20% of patients diagnosed with lung cancer have not received any treatment at all. In addition, black patients with lung cancer are 23% less likely to receive surgical treatment and 9% less likely to receive any treatment compared to white patients.

Before you get any treatment for lung cancer, it’s best to discuss it with a team of doctors, including a thoracic surgeon, because we have many different options for fighting your disease.