Advances in
Interventional Pulmonology
March / April 2006
Penn spearheads treatment options for patients with respiratory
disorders.
Interventional pulmonology, originally developed as a form
of palliation for patients with advanced thoracic malignancies,
has since grown into a field affecting all areas of respiratory
medicine. Today, advanced bronchoscopic and pleuroscopic
techniques are enabling interventional pulmonologists to
provide alternatives to surgery for many patients, including
those facing early-stage lung cancer and benign endobronchial
tumors.
“We can now stage cancers with real-time ultrasound
and diagnose early-stage cancer using autofluorescence bronchoscopy.
We can even cure conditions such as central microinvasive
lung cancer with non-surgical techniques like photodynamic
therapy,” says Daniel
Sterman, MD, Director, Interventional
Pulmonology and Associate Professor of Medicine at the Hospital
of the University of Pennsylvania.
Penn’s Interventional
Pulmonology program is part of the Penn Lung Center and,
as such, is a collaborative effort between the Divisions
of Pulmonary, Allergy, & Critical Care Medicine and Thoracic
Surgery, and the Departments of Radiation Oncology and Anesthesiology
and Critical Care. Penn offers one of just six interventional
pulmonology fellowships in the United States. Dr. Sterman
and Luis M. Seijo, MD, published what is considered to be
the first watershed article on interventional pulmonology
in the New England Journal of Medicine in March 2001
(Vol. 344, No. 10).
“The field is expanding well beyond its origins,” continues
Dr. Sterman. “For example, Dr.
Ali Musani, Associate
Director of Penn’s Interventional Pulmonology program,
and I are involved in ongoing clinical trials to evaluate
a variety of bronchoscopic approaches for emphysema and asthma.
One or more of these techniques may become standard clinical
practice in pulmonary medicine in the next five to 10 years.
Interventional pulmonology is also showing synergy with advances
in molecular medicine, as interventional techniques are utilized
to deliver experimental gene therapeutics for the treatment
of malignant disease as well as inherited genetic lung diseases.”
While the field of interventional pulmonology offers potentially
significant advances in the treatment of lung disease, there
are several techniques in use today that are already improving
the lives of patients. Among them are:
Endobronchial Laser Bronchoscopy
Lasers are used
to induce tissue vaporization, coagulation, hemostasis and
necrosis. The technique is useful in the ablation of endoluminal
malignant tumors, inflammatory strictures, obstructive granulation
tissue, amyloidosis and benign tumors.
Endobronchial Stenting
There are two main types of
stents, silicone and metallic. Silicone stents are placed
in the airway by use of a rigid bronchoscope and, as such,
the patient must be under general anesthesia. Metal stents
can be inserted with a flexible bronchoscope, often limiting
the use of anesthesia. There are advantages to each, depending
on the case.
Penn has the most active endobronchial stenting program
in the mid-Atlantic region. Penn interventional pulmonologists
are actively involved in new stent design and testing, as
well as novel indications of tracheobronchial stents, such
as stent-mediated gene delivery.
Endobronchial Brachytherapy
Tumors are treated through
the use of radioactive seeds implanted at the tumor site.
Here, a hollow catheter is inserted under fluoroscopic guidance.
The radioactive seeds are then inserted into the catheter
and left in position for a predetermined length of time.
Penn is one of the first centers in the nation to use low-dose
brachytherapy to treat and prevent airway stenosis related
to recurrent granulation tissue.
Onco-LIFE® Autofluorescence Bronchoscopy
The
Onco-LIFE® system will be an integral part of an
Early Lung Cancer Detection and Photodynamic Therapy Program
to be based at the Hospital of the University of Pennsylvania
under the director of Stephen
Hahn, MD, Chairman of the Department
of Radiation Oncology and Professor of Radiation Oncology.
Patients at high risk for the development of primary or recurrent
carcinoma of the lung will be candidates for the procedure,
which may detect cancers at early stages, when they may be
amenable to non-surgical treatments such as photodynamic
therapy.
“When it comes to current cases, physicians should
think of us as a partner, either to provide treatment options
and/or second opinions,” says Dr. Sterman. He notes
Penn interventional pulmonologists are routinely consulted
on cases such as:
- thoracic masses that have evaded mechanisms
of diagnosis;
- patients with a history of resected
cancer that need to be evaluated for the
possibility of recurrence;
- patients that present
with malignant effusions; and
- patients with hemoptysis,
especially those who have undergone previous
cancer treatment.
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