Brachytherapy Delivery System for Treatment of Lung Cancer

描述(申请人提供)：这一阶段的计划旨在开发一种改进的近距离放射治疗系统，用于肺癌的治疗，将放射性169Yb源加入用于肺切除的外科钉中。对于心肺状况不佳的患者，包括小叶下切除术在内的近距离放射治疗比单纯小叶下切除术在治疗结果上有显著改善。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照射的明显优势。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。这一进展将促进并从剂量上改善这种疗法的交付。在肺切除手术过程中通常使用的手术钉中加入169 Yb源，将允许在进行手术的同时应用肺部近距离放射治疗。当前技术面临的问题是如何在术中准确地提供近距离治疗源，以获得适当的剂量分布，并将执行该程序的临床医生的辐射剂量降至最低。我们的开发将有助于相对于手术边缘精确放置169Yb源，确保源在治疗期间保持在其精确位置，克服通过狭窄的外科切口操作源的技术困难，并减少对临床医生的辐射剂量。我们预计，这一进展将把近距离放射治疗的使用扩展到更多的肺癌患者，对他们来说，更传统的外科手术，如肺叶切除术，不是一种选择。这一进展将为心肺状况受损的患者提供近距离放射治疗的额外临床益处，从而改善他们的预后。由于现有技术的局限性，更精确的放射源定位和固定所产生的剂量分布的改善有望改善目前已确定的近距离放射治疗的临床益处。由于肺癌是美国癌症死亡的主要原因，这项计划对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 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.