CNN
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Two patients with stage IV lung cancer who were told they had only weeks or months to live are breathing freely after receiving double lung transplants, Northwestern Medicine in Chicago said Wednesday.
Lung cancer is the leading cause of cancer-related death in the United States.this The American Cancer Society estimates that more than 127,000 Americans will die of the disease this year.
Stage IV is considered once there are other tumors in the lung in addition to the primary tumor, or the cancer has spread to more organs.
People diagnosed with stage IV lung cancer have limited treatment options, according to Northwestern Medicine. Double-lung transplantation offers a potentially life-saving option for some people with a poor prognosis, but doctors say lung cancer patients must meet certain criteria, including that the cancer is located in the lung and that the patient has tried all other treatment options.
In 2020, Albert Khoury, 54, of Chicago, was diagnosed with a devastating form of lung cancer.
Khoury, a concrete finisher with the Chicago Department of Transportation, began experiencing back pain, sneezing and chills, and coughed up blood. According to Northwestern MedicineIt was close to the start of the Covid-19 pandemic, so at first, he thought he had coronavirus-related symptoms.
Not long after, he was diagnosed with stage I lung cancer.
Due to the pandemic, Khoury did not start treatment until July 2020. At that time, the cancer has progressed to stage II and continues to grow, eventually reaching stage IV. He was told to consider hospice, which is specialized care for people near the end of their lives, with an emphasis on comfort and support.
“I only have a few weeks to live,” Curry said in a video released by the hospital. “Not that much time.”
His sister suggested he contact Northwestern Medicine about the possibility of a double lung transplant.
“I need new lungs. It’s my only hope of living,” Khoury said he told his doctor.
He met with an oncologist at Northwestern Medicine, who told him he should try other treatments first. But it wasn’t long before he was in intensive care with pneumonia and sepsis.
As his health declined, oncologists began to consider the rarely used procedure.
Transplants are often considered for people who have some form of lung cancer that has not spread to other parts of the body, as well as those who have tried all other treatment options and have limited survival time, according to Dr. Ankit Bharat, chief of thoracic surgery at Northwestern. Canning Chest Institute of Medicine, who helped treat Khoury.
William Dahut, chief scientific officer of the American Cancer Society, also noted the importance of ensuring the cancer has not spread to other parts of the body before the transplant.
“There needs to be as much certainty as possible that the cancer is limited to the lungs, so whatever broad screening test should be done … to make sure there are no cancer cells outside the lungs,” said Dahut, who was not involved with any of the Northwestern patients care.
Oncologists deemed Khoury eligible for surgery. In September 2021, he spent about 7 hours in surgery.
“Surgeons must be extremely careful not to spill trillions of cancer cells from the old lung into Khoury’s chest cavity or blood,” Northwestern Medicine noted in a release.
The surgery is not without risks, Bharat said. In people with advanced cancer, there is always a chance that it will come back after surgery.
“There’s definitely a risk of something worse than before,” he said. “So you’ve had a major surgery, and then you’ve had the cancer come back very quickly.”
Another risk, Dahut said, is the treatment required after the transplant.
All lung transplant recipients must take drugs to weaken their immune systems, which helps reduce the likelihood their bodies will reject the organ — but also reduces their ability to fight infection, According to the National Cancer Institute.
“Drugs that actually suppress the immune system put you at risk for infection after the fact, but may even put you at risk for a second cancer after the fact,” Dahut said.
However, 18 months later, Khoury has returned to work without any complications.
His doctor showed him a chest X-ray, which showed no signs of cancer. “When I saw that X-ray, I believed him,” Curry said. “My body is in my hands now.”
The program is put to the test again Last year, this time it was a 64-year-old Minnesota woman.
Tannaz Ameli, a retired nurse from Minneapolis, had a persistent cough for months. Her doctor gave her a chest X-ray and diagnosed her with pneumonia.
The disease continued until she was told in January 2022 that she had stage IV lung cancer.
“There was no hope in my life at that time. They gave me … three months,” Ameli said in a video posted by Northwestern Medicine.
She underwent unsuccessful chemotherapy and was told to consider hospice.
“I had no hope. I was ready to end my life,” she said.
But her husband consulted with Northwestern Medicine about transplant options. Oncologists found Ameli met their criteria, and she underwent a double lung transplant in July.
When she was told the surgery had freed her from cancer, she wondered, “‘Am I sitting here dreaming? Could it happen? It did happen.
Ameli did not have any complications.
Double lung transplants are rarely done for cancer because of concerns that the cancer might recur, Bharat said.
Historically, surgery has required serial transplants, but they are looking to change the approach to reduce the risk of recurrence, he said.
“Usually, what happens in a double lung transplant is we take one lung out, put in a new lung, then take out the second lung and put in the second lung,” he said. “The concern is that when you take out one lung and put in a new one and the other lung is still attached, they could get cross-contaminated. … You could inadvertently spread cancer cells into the bloodstream .
If cancer cells cross-contaminate or enter the bloodstream, the risk of cancer recurrence increases.
Bharat and his team took a different approach with Khoury and Ameli: They opened their chests and performed a complete cardiopulmonary bypass.
“Essentially, what this means is, we’re not taking any blood going through the heart and lungs and bypassing all of that,” Bharat said. “This allows us to stop blood flow to the lungs, which will prevent any cancer cells from entering the blood from the lungs.”