Brachytherapy Delivery System for Treatment of Lung Cancer

描述（由申请人提供）：该I期项目旨在开发一种改进的近距离放疗给药系统，通过将放射性169yterium源加入肺切除术中使用的手术钉中来治疗肺癌。对于心肺功能受损的患者，包含小叶下切除术的近距离放疗比单独小叶下切除术的治疗结果显着改善。近距离放射治疗的明显优点是最大限度地照射肿瘤床，同时使周围的正常组织免受辐射场的影响。当所需的辐射剂量超过周围正常组织的耐受剂量时，这种方法特别有用。然而，后勤问题限制了近距离放疗在这些肺癌应用中的应用。这一发展将促进并从剂量学上改善这种治疗的递送。在肺切除术过程中通常使用的手术钉中加入169个镱源，将允许在手术进行的同时应用肺近距离放射治疗。当前技术面临的问题是能否在术中精确地传递近距离治疗源，以达到适当的剂量分布，并使临床医生进行手术的辐射剂量最小化。我们的开发将有助于在手术边缘精确放置169镱源，确保源在治疗过程中保持固定在其精确位置，克服通过狭窄手术切口操纵源的技术困难，减少临床医生的辐射剂量。我们预计，这一进展将使近距离放疗的应用范围扩大到更多的危重肺癌患者，这些患者无法接受传统的手术治疗，如肺叶切除术。这一发展将为心肺功能受损的患者提供近距离放疗的额外临床益处，从而改善他们的预后。由于目前技术的局限性，更精确的光源定位和固定所带来的剂量分布的改善有望提高目前确定的近距离放射治疗的临床效益。由于肺癌是美国癌症死亡的主要原因，因此该项目对临床结果的任何改善都将转化为显著的社会效益。

DESCRIPTION (provided by applicant): This Phase I program intends to develop an improved brachytherapy delivery system for treatment of lung cancer by incorporating radioactive 169Ytterbium sources into surgical staples used in lung resection. For patients with compromised cardiopulmonary status, the inclusion of brachytherapy with sublobular resection has shown a significant improvement in therapeutic outcome over sublobular resection alone. Brachytherapy has the obvious advantage of maximally irradiating the tumor bed while sparing surrounding normal tissue from the field of radiation. This approach has been especially useful when the required radiation dose exceeds the tolerance dose of the surrounding normal tissues. However, logistic issues have limited the application of brachytherapy in these lung cancer applications. This development will facilitate and dosimetrically improve the delivery of this therapy. The incorporation of 169 Ytterbium sources into the surgical staples normally used during the lung resection procedure will permit the application of lung brachytherapy at the same time as the surgery is being performed. The problem facing the current technique is in the ability to precisely deliver the brachytherapy sources intraoperatively to achieve the proper dose distribution and minimize the radiation dose to the clinicians performing the procedure. Our development would facilitate the precise placement of 169Ytterbium sources relative to the surgical margin, assure the sources remain fixed in their precise position for the duration of the treatment, overcome the technical difficulties of manipulating the sources through the narrow surgical incision, and reduce the radiation dose to the clinicians. We anticipate that this development will extend the use of brachytherapy to a much larger number of compromised lung cancer patients for whom more traditional surgical procedures, such as lobectomy, are not an option. This development will afford the additional clinical benefit of brachytherapy to patients with compromised cardiopulmonary status, thereby improving their outcomes. The improved dose distribution resulting from more precise source positioning and fixation is expected to improve the currently identified clinical benefit of brachytherapy due to the limitations of the current technique. Because lung cancer is the leading cause of cancer deaths in the United States, any improvement in clinical outcome resulting from this program will translate into significant societal benefit.