Clinical summary:
A 71-year-old man was referred to our thoracic surgery clinic for
surgical assessment. He was a former smoker with a history of over 20
pack-years taking rivaroxaban for an atrial fibrillation and
beta-blockers to treat hypertension. A computed tomography (CT) scan
demonstrated a 1.2 cm spiculated nodule in the posterior segment of the
right upper lobe (RUL) (Supplementary Figure 1). Positron emission
tomography (PET)/CT showed a standardized uptake value (SUV) maximum of
5.9 in the nodule, and without lymph node or extra-thoracic involvement.
His cranial CT was normal. The case was reviewed by our
multidisciplinary lung tumor board, and the patient was deemed
appropriate for surgery, with a planned RUL lobectomy and mediastinal
lymphadenectomy.
The Institutional Review Board (IRB) of Salamanca University Hospital
approved the study protocol and publication of data. The patient
provided informed written consent for the publication of the study data.
This is a treat-and-resect study evaluating the safety and feasibility
of Aliyaâ„¢ Pulsed Electric Fields (PEF) [Galvanize Therapeutics, Inc.,
Redwood City, CA] in patients with non-small cell lung cancer (NSCLC)
tumors prior to surgical resection. The Aliya PEF system delivers a dose
of non-thermal, high-voltage, and high-frequency electrical currents
through a single monopolar electrode placed in the target tissue. The
PEF energy destabilizes the cells, resulting in cell death, while
preserving the stromal elements of tissue.
Sequential procedural access options were planned to limit the
likelihood of a non-diagnostic biopsy result. In the hybrid OR, an
initial bronchoscopic approach was taken by the thoracic surgeon to
access the lesion. An alternate percutaneous cone-beam CT (CBCT)-guided
approach by the interventional radiologist was planned in case the
catheter was unable to be localized at or directly adjacent to the
target using the bronchoscopic approach.
Appropriate navigation was unable to localize the catheter within the
lesion and the closest position was roughly 4 mm lateral (Figure 1).
Various attempts to improve the position were unsuccessful, therefore
the bronchoscopic approach was abandoned and the patient was
repositioned for a percutaneous approach.
The conversion to the percutaneous approach resulted in successful
lesion access and biopsies were obtained. Intraprocedural diagnosis
demonstrated malignancy, specifically NSCLC favoring adenocarcinoma. The
percutaneous diagnostic instrument was withdrawn, and the PEF
percutaneous needle and electrode were positioned within the lesion
(Figure 2). PEF energy was delivered successfully. The PEF energy
delivery apparatus was withdrawn, and the patient was moved to the post
anesthesia care unit (PACU) without incident and discharged.
The patient returned to undergo surgical resection 19 days later, which
was performed via robotic assisted thoracic surgery. The surgical field
was confirmed to be unaffected by the prior PEF energy delivery. The
patient developed a non-continuous air leak in the immediate
postoperative period and was discharged one week later following
resolution.