New lung cancer study ‘to prompt a paradigm shift in clinical practice’

MedTech & Diagnostics News: A significant advancement in the pre-treatment testing of lung cancer patients has emerged through a collaboration led by the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne.

The landmark SEISMIC study, conducted across multiple centres internationally, including sites in Melbourne, the Netherlands, USA, and Canada, marks the first prospective demonstration of the benefits of endoscopic staging in non-small cell lung cancer (NSCLC) patients with locally advanced cancers.

Patients with locally advanced NSCLC, whose cancer has not metastasised, stand a chance of cure through precise radiotherapy targeting. Conventionally, treatment planning relies heavily on positron emission tomography (PET) scans to delineate the extent of cancer spread.

However, the SEISMIC study introduces a new approach, augmenting PET scans with a endoscopic procedure aimed at detecting any potential escape of cancer cells from the primary tumour site. This procedure entails navigating a camera down the windpipe, coupled with an ultrasound-guided needle to extract tissue samples, including those from lymph nodes in the chest cavity.

Professor Daniel Steinfort, lead author of the study and a Respiratory Physician at the Royal Melbourne Hospital and Peter MacCallum Cancer Centre, as well as a Principal Research Fellow at the University of Melbourne, elucidates the significance of these findings.

“Our study underscores the inadequacy of relying solely on PET scans for accurate disease mapping in NSCLC patients,” Professor Steinfort asserted. “For approximately one-third of the patients, the endoscopic staging provided more precise insights into the extent of their disease.”

Crucially, discrepancies were identified in 37% of patients when comparing the endoscopic findings with PET scans alone. Furthermore, in 12% of cases, escaped cancer cells were detected in lymph nodes, profoundly influencing treatment strategies.

Professor Steinfort added “Had these treatments relied solely on PET scans, the escaped cancer cells would have received only around 10% of the required radiotherapy dose, significantly elevating the risk of treatment failure.”

Echoing these sentiments, Professor Shankar Siva of Peter MacCallum Cancer Centre, the senior author of the paper, emphasised the potential global impact of the SEISMIC findings.

“Relying solely on PET scans for treatment planning may not afford many patients the optimal chance of a cure,” Professor Siva stated. “The implications of the study are profound and are likely to prompt a paradigm shift in clinical practice worldwide.”

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