Brachytherapy Delivery System for Treatment of Lung Cancer

描述（由申请人提供）： 该II期项目旨在通过将放射性169镱源纳入肺切除术中使用的手术斯台普斯中，继续开发用于治疗肺癌的改良近距离放射治疗输送系统。对于心肺功能受损的患者，近距离放射治疗联合小叶下切除术的治疗结果比单纯小叶下切除术有显著改善。近距离放射治疗具有最大限度地照射肿瘤床，同时使周围正常组织免受辐射的明显优势。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射治疗在这些肺癌应用中的应用。这一发展将促进和剂量学改善这种治疗的交付。将169镱源结合到肺切除术过程中通常使用的手术斯台普斯中，将允许在进行手术的同时应用肺近距离放射治疗。当前技术所面临的问题是在术中精确地递送近距离放射治疗源以实现适当的剂量分布并最小化对执行手术的临床医生的辐射剂量的能力。我们的发展将促进169镱源相对于手术边缘的精确放置，确保源在治疗期间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，并减少对临床医生的辐射剂量。我们预计，这一发展将扩大近距离放射治疗的使用，以更多的妥协肺癌患者，更传统的外科手术，如肺叶切除术，是不是一个选择。 公共卫生相关性： 这一发展将为心肺功能受损的患者提供近距离放射治疗的额外临床受益，从而改善其结局。由于当前技术的局限性，预期更精确的源定位和固定导致的剂量分布改善将改善近距离放射治疗的当前确定的临床受益。由于肺癌是美国癌症死亡的主要原因，因此该计划导致的临床结果的任何改善都将转化为重大的社会效益。

DESCRIPTION (provided by applicant): This Phase II program intends to continue 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 169Ytterbium 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. PUBLIC HEALTH RELEVANCE: 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.