Lung cancer can now be diagnosed and treated at the same time using a new type of robotic surgery. Margaret Kirkham, 77, a retired careers officer from Chiswick, West London, was the first patient in the world to have the new two-in-one procedure, as she tells ADRIAN MONTI.
The patient
Just over two years ago, I suddenly became more breathless — and would even have to stop talking mid-sentence to catch my breath. My GP examined me and sent me to A&E for tests, including a chest X-ray.
I got a call the next morning to come straight back for a CT scan as it looked as if part of my lung had collapsed. I was quite shocked.
A doctor explained that a large mass had been found on my left lung, which looked like cancer. Luckily, they told me, it had not spread.
Margaret Kirkham, 77, was the first patient in the world to be treated with the 2-in-1 method
I used to be a smoker but had given up 20 years before, and although I was told my cancer was probably not caused by tobacco because of its molecular structure, I still felt guilty.
My tumour measured 7cm by 6cm by 6cm: I pictured it as a large solid rectangle. It couldn’t be surgically removed as it was close to my heart and entwined in the main airways to the lung. This sounded dreadful, but my consultant reassured me that it was slow-growing and could be controlled with treatment.
In April 2022, I began chemotherapy and radiotherapy and it worked quickly, with my lung reinflating, making breathing much easier.
A scan that July showed the tumour had shrunk dramatically. I then had monthly immunotherapy until last August. By then, the original tumour had gone — but there was a small new nodule, on my left lung. It wasn’t safe to have any more radiotherapy, though, and I couldn’t have surgery.
But my consultant mentioned a new technique was being trialled for smaller, hard-to-reach lung tumours. This involved ablation, where heat is used to destroy cancer. I was referred to Professor Pallav Shah, the lung specialist responsible for the trial.
He explained I’d be given a general anaesthetic, then a flexible tube would be guided down my windpipe. Attached to a sophisticated robotic system, it could navigate deep into my lungs to take a biopsy and then they’d use a tiny ablation tool to use heat to destroy tiny cancerous nodules.
After the surgery in November, I felt fine — and with no pain.
It put a smile on my face to learn that I was the first to have this procedure. I’d never been first at anything before!
Scans showed the tumour was successfully ablated and I was back to my usual life within a week. I have slight breathlessness due to scar tissue from the ablation and radiation, but that’s a small price to pay.
I’m not on any medication and feel well and positive and I am making up for lost time — I’ve just been on a painting trip to Cadiz. I’m extremely grateful to have been on this trial, which will hopefully benefit many others.
The specialist
Professor Pallav Shah is a consultant physician in respiratory health at the Royal Brompton Hospital in London.
Lung cancer is the UK’s third most common cancer, with 40,000 cases diagnosed annually and a very low survival rate. (Just 20 per cent of patients live five years or longer).
This is because it does not cause obvious symptoms so is generally picked up at an advanced stage, often during investigations for complaints such as persistent cough, weight loss or chest pain. But if we can treat tumours when they’re smaller than 10mm, the cure rate is 92 per cent.
Currently, most people are diagnosed when the cancer spot, or nodule, is above 30mm, where the cure rate is 68 per cent.
Since April last year, we’ve been using a pioneering robotic-assisted system, the Ion Endoluminal System, at the Royal Brompton. Using a robotically-controlled catheter system, it can reach nodules as small as 6mm.
This allows us to carry out a minimally-invasive biopsy on any part of the lung, even in places normally very hard to reach within the tiny bronchioles, or branches, of the airway ‘tree’.
Lung cancer is the UK’s third most common cancer, with 40,000 cases diagnosed annually
We can also now use the Ion system with a new ablation tool, using heat to destroy the cancer, for patients who are not suitable for conventional surgery or radiotherapy,
Currently, a standard lung cancer biopsy involves inserting a needle through the chest wall and into the lung, using a CT scanner for guidance.
This is done under general anaesthetic, and results take a week. There is a risk of lung puncture (this occurs in 25 per cent of cases), which can lead to bleeding, clots, stroke and even death. It’s inappropriate for patients with poor lung function (e.g. those with severe emphysema), or nodules in a difficult location.
The robotic approach, also carried out under general anaesthetic, has a less than 10 per cent risk of pneumothorax — collapsed lung. We biopsy to check the nodule is cancerous before ablating.
First, a CT scan of the lungs is uploaded on to the Ion system, giving a very detailed 3D roadmap of the inside of the lungs. The system automatically plots a route to the nodule.
An ultra-thin, flexible tube (catheter) is then passed into the patient’s airway via their mouth, while we monitor progress on a screen. Once the catheter reaches the nodule, the needle is deployed to collect a tissue sample.
Not only does it enable us to target smaller nodules more precisely, but the robotic catheter is much more flexible than the conventional bronchoscope (a flexible camera used to examine the airways).
The bronchoscope can only reach 65 per cent of spots smaller than 20mm, but the robotic system reaches more than 90 per cent of spots smaller than 10mm.
We can also now treat the patient during the same session.
Margaret was the first patient in the world to have a biopsy and robotic microwave ablation done in a single 45-minute procedure, sparing her a subsequent 30–45 minutes of ablation treatment.
This is thanks to another technological advance — a new type of ablation tool called the MicroBlate Flex, developed by UK company Creo, which is just 1.8mm in diameter.
This goes via the same robotic catheter through which the biopsy was performed, so you biopsy and treat the exact same spot. This could not be done with standard ablation tools, which have to go through the chest wall.
Margaret’s lung nodule measured under 10mm but we also ablated a margin to ensure all cancerous tissue was destroyed. It took three minutes to ablate.
The beauty of microwave energy is we can repeat it if necessary, which isn’t the case with radiotherapy, where you can only administer a certain amount because of damage to tissue.
Doing two procedures at once is a game-changer, saving time for both clinicians and patients, who are also spared a delay between biopsy and ablation, during which their cancer continues to grow.
Patients on the trial stay in overnight but it should be a day procedure in future. We aim to use it to treat small, early cancers in patients not suitable for surgery — they may, for instance also have heart disease.
Although we need to send biopsy samples taken using the Ion to be analysed, which can take a week, in future we hope to use AI to analyse them within a few minutes, enabling us to ablate straight away.
In Margaret’s case, we were already confident her nodule was cancerous (because of previous treatment) so we did a biopsy immediately followed by an ablation to demonstrate the two-in-one technique could successfully be performed.
We have so far performed the ablation on nine patients, with no serious side-effects.
Source: Mail Online
