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. ? ? ?
