Robotics could help diagnose and treat lung cancer in one procedure

There are hopes that lung cancer could be diagnosed and removed from patients in one sitting in the future thanks to robotics, according to medics trialling the technology.

The method allows doctors to target and remove nodules on the lung with millimetre precision.

Using robotics in this way has the potential to be “transformational” for both patients and hospital waiting lists, experts said.

Before the procedure, a CT scan is performed and passed through software to create a detailed 3D road-map of the inside of the patient’s lungs from the mouth to the location of the cancer.

A thin, robot-guided tube, or catheter, is then passed through the patient’s mouth and into the airways, following this road-map.

Once located, cancer cells are destroyed using heat in a process known as microwave ablation.

Professor Pallav Shah, a consultant respiratory physician based at Royal Brompton Hospital in London, said: “We can get to the nodule really precisely.

“The first patient we treated was quite interesting – she had already had lung cancer and chemotherapy and radiotherapy, but then developed a spot in the radiation field.

“She couldn’t have more radiotherapy and wasn’t eligible for surgery. We had to be millimetre precise – and we were. She’s now – over six months down the road – doing really well.”

The team has treated a further six patients since then. Prof Shah added: “Generally we’re getting good results, but it’s just early days.”

Current ablation treatments involve performing a CT scan on a patient to locate the cancer and inserting a needle through the skin and straight into the tumour in order to destroy it.

This can involve multiple ablation attempts, taking “well over an hour, maybe 90 minutes”, according to Prof Shah, and carries a risk of puncturing the lung.

The procedure being trialled Prof Shah and his team takes between 40 and 45 minutes, although the ablation stage only takes three minutes.

Navigational bronchoscopy – when a narrow tube is passed through the mouth into the airways, allowing doctors to examine nodules – is successful in identifying lung cancer about 65% of the time, according to Prof Shah.

However, introducing robotics increases the success rate “dramatically”, bringing it “close to 95%”, he added.

He said there is “a lot of work to be done, but a lot of early promise” and in the future, he would like to see diagnosis and treatment of lung cancer in the same sitting.

A current trial is aiming to treat 32 lung cancer patients who are not fit or eligible for surgery to determine the safety of the procedure and the recurrence rate of cancer.

The next step will be a trial that uses the method on patients who are eligible for surgery.

One of the biggest comparisons of the new method’s safety will be radiotherapy, which works by using radiation to kill cancer cells but has a number of side effects.

One such side effect is pneumonitis – or inflammation of the lung – which Prof Shah said can be “very unpredictable and can lead to profound damage and breathlessness”.

According to the WHO, lung cancer is the most common cause of cancer death, killing some 1.8 million people around the world every year. Smoking is the most common cause, accounting for about 70% of cases, according to the UK's National Health Service (NHS).

The disease is more likely to be treated successfully if caught early. “It’s really important to find these tumours early,” Prof Shah said.

“Usually we only intervene if the nodule is more than 10mm in size or has been showing some suspicious changes, or growing. If it’s between six and 10mm we’d be following up with a scan in three months. But patients don’t like not knowing what it is. We don’t want to be overenthusiastic, but we don’t want to miss cancer.”

Creo Medical is a medical device developer which designed the microwave ablation tool used in the procedure.

The company’s chief executive, Craig Gulliford, said: “Combining diagnosis and treatment in one procedure could potentially be transformational – this reduces the need for the patient to return for a separate, more invasive procedure, which is the current standard of care.

“By removing the gap between diagnosis and treatment, it eliminates the long anxious wait for potential treatment that patients currently have to go through, but it also means that patients can get treatment before a nodule has time to grow in size or spread to other parts of the body.

“Currently, there is no early screening that takes place for cancer as there are no effective treatments for these early nodules, but this technology can allow treatment to take place earlier, at the point of diagnosis and in a less invasive manner, before these nodules become more serious.”

He added that the adoption of technology in this way “could be of great benefit” when it comes to bringing down hospital waiting lists.