A new study may make the invasive surgeries required to treat lung cancer a thing of the past.
Dr. Drew Moghanaki of McGuire Veterans Affairs Medical Center is co-chairing a $25.2 million clinical trial that will help determine whether surgery or a stereotactic radiation treatment is the most efficient way to treat lung cancer.
Lung cancer is the leading cancerous cause of death for both men and women in the country, according to the American Lung Association, and death caused by the cancer has increased by about 3.5 percent between 1999 and 2012.
Stereotactic radiation treatment evolved about 15 years ago, Moghanaki said. It involves using new imaging technology to target tumors with far greater precision than other types of radiation.
Previously, the area around a tumor, in addition to the tumor itself, was targeted with radiation to ensure that none of the cancer was missed.
Yet the precision of stereotactic radiation negates that necessity, so the radiation level can be increased and the treatment completed in just three outpatient sessions, while conventional radiation requires 30 treatments.
This type of treatment has numerous positive benefits that surgery lacks, including a less invasive procedure and shorter recovery time, Moghanaki said.
“So it has been begging the question,” he said, “if outpatient treatments that a patient could get potentially on their lunch break might be just as good as surgery, why are we still routinely recommending surgery?”
The research began about 15 years ago, Moghanaki said, and since then the results have been reproduced all over the world. But a study of this magnitude, he added, is necessary to definitively prove that the radiation is a better and safer option than surgery.
The study is sponsored by the U.S. Department of Veterans Affairs’ Cooperative Studies Program, which approved the idea after Moghanaki and his team worked on it for more than three years. The study’s other chairman, along with Moghanaki, is Dr. Tomer Karas, a surgeon with a VA medical center in Miami.
It could be about nine years before the results become clear, Moghanaki said. While the study will begin this fall, it will likely take four years to enroll patients, who will be followed through their treatments for another five years.
Moghanaki, who also is an assistant professor with Virginia Commonwealth University’s Massey Cancer Center, will help conduct the study in which he and health care providers from 16 other VA medical centers around the country follow 670 patients through their respective treatments to measure which produces the most efficient, safest results.
“The study may show that surgery is in fact the preferred treatment, and that’s a good reason to preserve it,” Moghanaki said. “Or it might show that radiation is just as good and maybe safer.”
About 40 patients from McGuire will be enrolled in the study, he added, and will be randomly split between radiation and surgical treatments.
Surgery to remove a lung cancer tumor has been the standard of care for decades, Moghanaki said. For those with stage 1 lung cancer, the survival rate can be upward of 70 percent.
“So that’s the benchmark that radiation has to be able to reach if it’s going to be considered an acceptable alternative,” he said.
The U.S. Preventive Services Task Force, an independent panel of national experts in prevention and evidence-based medicine, recommends screening for lung cancer in adults ages 55 to 80 who currently smoke or have quit within the past 15 years in an effort to catch the cancer as early as possible. Smoking contributes to 80 percent of cases of lung cancer in women and 90 percent in men.
Stereotactic radiation already is used in elderly patients who cannot tolerate surgery.
“What’s great is that these frail patients really tolerate [the radiation] very well, without having major complications,” Moghanaki said.
The study will likely be able to determine if radiation is the safest route for all patients.
“It’s very exciting, this idea of challenging the long-held belief that surgery offers the only hope for cure,” Moghanaki said.