Adenoid Cystic Carcinoma and Lung Cancer Overview and Treatment Choices
SEED BRACHYTHERAPY FOR ESOPHAGUS CANCER, LUNG CANCER AND ADENOID CYSTIC CANCER (ACC) OF THE LUNG
CAT Scan Guided Seed Brachytherapy for Lung and Adenoid Cystic Cancer (ACC) is a minimally invasive outpatient method of treating all types of cancers in the lung, liver and pelvis. Treatment is performed as a 30 minute outpatient procedure and patients go home the same day and return to all activities the following day. Implanted cancers typically disappear and usually do not recur1.
1. Brachytherapy Vol 13, S107-108 Mar 2014
Management of Adenoid Cystic Carcinoma Metastatic to Lung with CT-Fluoroscopic Guided Brachytherapy
Published Brachytherapy Vol 13,S107-108 Mar 2014
Author Block: Stephen Doggett, MD1, Shigeru Chino, MD2, Todd Lempert, MD3.
1Radiation Oncology, Mission Regional Medical Center, Mission Viejo, CA, USA,
2Thoracic Surgery, Mission Regional Medical Center, Mission Viejo, CA, USA,
3Radiology, Mission Regional Medical Center, Mission Viejo, CA, USA.
A description of management of metastatic adenoid cystic carcinoma with multiple ct guided palladium seed implants in a single patient resulting in complete response.
Materials and Methods
Patient received 16 separate site implants over 20 months. CT/fluoro scanning was used to localize lesion followed by palladium seed insertion via percutaneous 18 g needle. Results: PET/CT 14 months following last implant shows no evidence of disease. Patient had no pneumothorax with any implant. Average implant time was 15 minutes.
Percutaneous CT guided palladium seed implant is an effective method of managing multiple pulmonary metastasis with minimal morbidity.
Presented at American Brachytherapy Society Meeting 2016
Management of Metastatic Adenoid Cystic Carcinoma (ACC) to lungs, liver and adrenals by CT/Fluoroscopy guided radioisotope seed implant
Stephen Doggett MD www.nocancer.com 7-28-12
ACC is a difficult disease to treat after it has spread from the primary site to the lungs. Multiple thoracotomies to remove these metastasis carry the risk of any surgical incursion into the chest as well as the risk of diminishing pulmonary gas exchange capability. This can result in poor exercise tolerance and even cause the patient to be house or bed bound due to severe lung insufficiency. Radiofrequency ablation is a fairly effective therapy but has a significant risk of pneumothorax due to the large size catheter and long treatment times. Additionally, RF cannot be used close to the heart for fear of damage to the muscle or conduction pathways responsible for keeping the heart beating. Current systemic therapies with multikinase inhibitor molecules have shown some promise, but for short times only and with often unacceptable side effects.
Implanting tiny radioactive sources through thin (18g or 20g) needles into the primary lung cancers or lung metastasis was started by our group in 1991 in Orange County California. We have now implanted several hundred patients, several dozen with ACC. In addition we have also implanted metastasis of all types in the kidney, adrenal, liver and neck lymph nodes. We have had no operative deaths and only a handful of minor pneumothoraxes that required chest tube.
Accurately implanted lesions that receive sufficient radiations will resolve and not return at least 90% of the time. Smaller lesions are easier to sterilize completely and larger lesions may require a second implant to touch up areas that were under dosed at the first seeding.
It is therefore always in the patients best interest to seek consultation for seeding when the chest tumors are as small as possible. Smoking cessation and regular aerobic exercise conditions the lungs for maximal gas exchange before and after the implants.
Typically, two or three of the largest lesions in each lung are implanted, one lung on one day and the other lung the following day. The patient can safely fly home even after both lungs have been implanted. The implanted patients pose no risk to family members, pregnant women, children or pets.
Modern CT scanners combined with fluoroscopy allow the targeted area to be images in real time as the needle is inserted toward the target. The physician can follow the needle tip in 3d to closely and safely approach tumors adjacent to nerves, blood vessels, the heart and bronchi.
Intent of seed implant therapy is to substantially reduce the tumor burden in the chest over several seeding sessions. By reducing the tumor burden, the chance of metastasis to other sites is sharply reduced thus likely prolonging survival. By treating metastatic ACC as a chronic disease with multiple implants separated by months or years, survival is likely prolonged, giving time for new investigational molecules to be brought to clinical use.