New Techniques At UTHSCT Puts Hospital In Forefront Of Technology By COSHANDRA DILLARD, Staff Writer   |   Sep 24, 2008

A lung cancer diagnosis used to signal great odds patients, but with groundbreaking technology, the outlook on the battle of lung cancer and other pulmonary diseases is brighter. Medical officials at the University of Texas Health Science Center at Tyler are now at the forefront of innovative ways to diagnose and treat lung diseases.

Interventional pulmonology is a relatively new field in which physicians utilize noninvasive ways to stop the progression of lung diseases. This is particularly important for lung cancer patients, as they are generally not good candidates for surgery.

A special interventional pulmonary lab opened at the center last year and is undergoing construction to accommodate a new procedure -- brachytherapy. Interventional pulmonology has been around for about five years and is growing in development, much like interventional cardiology was 15 years ago.

Techniques used in the field include brachytherapy and electromagnetic navigation bronchoscopy. These procedures are safe, noninvasive and detect and treat malignant and nonmalignant pulmonary diseases quicker than traditional methods, medical officials say. UTHSCT is one of only six centers in the U.S. that has these capabilities.

NO. 1 KILLER

Lung cancer has been especially difficult to treat due to the structure of the lungs, said Dr. Ted McLemore, a world-renowned interventional pulmonologist and director of interventional pulmonology at UTHSCT. He has practiced medicine for 27 years and says a diagnosis of lung cancer is oftentimes very "dismal."

"Lung cancer is the number one cancer killer in adults in the U.S.," he said. "It kills more than colon, breast and prostate cancers combined. It surpasses breast cancer as the number one cancer in women."

Lesions can go undetected in the lungs for many years and patients will not experience any symptoms until tumors get very large, causing shortness of breath, pain or bleeding.
"That's why it is so devastating," he said. "The lesions can grow two or three times in size and spread. So it is important to get a diagnosis at a much earlier stage."

Dr. McLemore said that only 10-15 percent of people diagnosed with lung cancer survive for more than five years.

INNOVATION

The lung's structure is similar to a tree, with branches, or bronchi, that break into even small branches called bronchioles and lead to tiny air sacs called alveoli. Because of this structure and the fact that abnormalities in the lungs can move, it may be difficult to make an early diagnosis, Dr. McLemore said.

In treating lung cancer patients, brachytherapy is different from radiation therapy in that physicians place tiny pellets inside the patient's body, allowing doctors to deliver high doses of radiation to a concentrated area; whereas before, patients had to undergo powerful energy waves to kill cancer cells via a large machine.

In patients with emphysema or bronchitis, the lung function is oftentimes very low and using brachytherapy instead of traditional external radiation prevents more destruction of their lung functions. Patients suffer fewer side effects and have a shorter recovery time. UTHSCT is the first hospital in the country to try brachytherapy. The only other hospital in the world to have it available is in Heidelberg, Germany.

Dr. McLemore has performed the procedure at his Paris clinic. Comparing the high dose radiation to ground zero at Hiroshima, he said it destroys the blood supply at the center of a tumor and takes about three minutes to complete.

Although it is too early to calculate survival rates, brachytherapy shows some promise, Dr. McLemore said. Of the 12 patients he has administered it to, 11 are still living. He said it began 18 months ago, and he is following up with CT scans to make sure there are no residual lesions. "Early results are promising," he said.

Another procedure, electromagnetic navigation bronchoscopy, is similar to a global positioning system (GPS). Doctors use a high resolution CT scan to plot a "roadmap" to the lesion as small as six millimeters. A high resolution CT scans thin cuts of the lungs, giving physicians a three-dimensional view of the lung. This "map" or pathway to the lesion is necessary to perform a biopsy and takes about 30 minutes to complete. UTHSCT pulmonology pathologist Dr. Timothy Allen assists Dr. McLemore with these procedures. He is the chairman of pathology at UT Health Science Center at Tyler and the only pulmonary pathologist in North Texas. He is also one of only about 100 in the world. Dr. Allen has collaborated with Dr. McLemore for more than a year. His primary roles are to biopsy tumors, study individual cells under a microscope and give a diagnosis.

ON THE HORIZON

Among the new procedures on the horizon at UTHSCT is the use of optical confocal tomography. It allows doctors to use a special generated light to look at individual cells in the lungs, which will help make a diagnosis without taking a biopsy.

"It is still in the very early experimental stage," Dr. Allen said. "It's new technology in which we are attempting to diagnose lesions, whether they are malignant or non malignant. We are taking tissue and seeing cells at a high level of magnification. It is extremely experimental."

Dr. Allen has worked with researchers at UTHSCT as well as other pulmonary pathologists, across the country and the world. He explains pulmonary pathology as "intriguing and challenging." He said there is continual research for asthma, pleural fibrosis and tuberculosis treatments.

Dr. McLemore has spent most of his medical profession seeking ways to improve pulmonary diseases.
"My main research interest since 1976 has been lung cancer," he said. "In the last 40 years, there has been no increase in the survival rate despite all advances in molecular biology.

He added, "This is the most exciting thing I've ever been associated with. We are on the cutting edge of interventional pulmonology. We are at the forefront of the world with this type of approach."