TOWARDS LESS INVASIVE PROCEDURES

At present, patients suspected of having lung cancer must undergo several examinations to determine the stage of their disease. In general,these procedures involve surgery under general anaesthesia. However, the risks to the patients, not to mention the associated costs, are quite high. Finding less invasive diagnostic techniques could limit these dangers and also improve the quality and reliability of the diagnostic information obtained. Drawing on a cohort of 166 cancer patients,   Dr Liberman is currently conducting a clinical research project aimed at comparing traditional surgical approaches to cancer staging to two endoscopic procedures, endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS).

Endoscopic procedures involve inserting a tube equipped with a camera into a body cavity. EBUS and EUS use this technique with the addition of ultrasound to examine respiratory and digestive pathways. The ultrasound components provide a more in-depth image to evaluate the extent of damage to the lymph nodes that drain the cancer cells from the lungs.

Although these techniques have been studied in the past,Liberman’s project is the first
to examine a large number of patients using both traditional surgical procedures and
endoscopic approaches. The advantage: there are no “false negatives”; that is, there is no error since the cancer stage is determined by both methods for all patients. The goal is to see not only whether endoscopic procedures can replace surgery, but also to improve diagnostic accuracy and thereby select the best treatment strategy: surgery, chemotherapy and/or radiotherapy.

ENCOURAGING RESULTS

While the study is still ongoing, early data have revealed some advantages of endoscopic procedures over surgery. EBUS and EUS make it possible to see more of the lung and, more importantly, to get a better picture of the cancer’s extent and spread than would be obtained with surgical diagnosis. “Moreover,” notes Liberman, ”if we ask patients whether they prefer general anaesthesia and associated side effects or to undergo less invasive tests, they will invariably choose the latter without a second thought.”

“Our goal,” says Liberman, “is to eliminate surgery as a means of evaluating lung cancer stages.” There is less pain and suffering and no need for general anaesthesia. There are also fewer complications requiring hospitalisation, reduced demands on operating rooms, and, more importantly, patients are better off as a result.  “We already have everything we need for EBUS and EUS,” notes Liberman, “and if our study results show that they are better than surgery, they will be used daily in our practice and will radically alter lung cancer staging procedures throughout the world.” They will also have equally profound implications for the quality of life of cancer patients.