Lighting Up Lung Cancer

New surgical tool lets surgeons see lung cancer cells during surgery.

Removing lung cancer is a balancing act, says Clark Fuller, MD, Torrance Memorial’s medical director of thoracic surgery. “It can be difficult to be sure we’re removing all of the cancerous cells, so we end up excising tissue around the cancer,” he explains. “We cannot compromise a safe margin around the cancer, but we want to preserve as much normal lung as possible too.”

Torrance Memorial’s new Cytalux tool tips the scales in surgeons’ favor, allowing them to spot, target and remove individual lung cancer cells—eradicating the cancer and preventing it from spreading.

Cytalux literally lights up cancer cells. Before surgery, patients are administered a single dose of the drug—a compound combining a form of folate (vitamin B9) with a marker dye. The folate binds to cancer cells, and the marker dye fluoresces when illuminated with a near- infrared light, making it easy for surgeons like Dr. Fuller to spot them during surgery.

Last year Torrance resident Diane Booth became the first patient to benefit from the new technique at Torrance Memorial. Booth had already beaten gallbladder cancer, but a routine follow-up scan analyzed by an artificial intelligence imaging system revealed a small nodule in her lung—too small to be seen with traditional imaging techniques. The nodule was also too small to be biopsied and definitively diagnosed as cancer, so she was scheduled for surgery to identify and remove the nodule in a single procedure.

Booth was administered Cytalux through a standard IV about an hour before surgery. “When I actually looked in her chest and saw this color right where I anticipated it would be, it was enormously comforting,” recalls Dr. Fuller. “I knew then that the operation was going to be efficient and successful.”

“I didn’t experience any significant side effects,” says Booth. “I woke up feeling good, although there was definitely some pain. They were on top of it though; they were great with pain management.”

The comparison with her treatment for gallbladder cancer is “like night and day,” she says. With the precision and confidence Cytalux afforded Dr. Fuller and his team during the operation, “they were able to pinpoint it and get all of it, no guessing. I didn’t need chemo or radiation, and I was in the hospital for less than a week. Of course we’re monitoring it to make sure I’m good.”

Cytalux was approved for use in lung cancer treatment by the FDA in 2022, and Torrance Memorial is the only Southland medical center to offer it as a treatment option. “We run a very high-performing thoracic oncology program here,” says Dr. Fuller. “I hear about a lot of cutting-edge products, including Cytalux. After some research, it became clear to me it would be a very useful aid during procedures.

“With the advent of new lung cancer screening programs, in particular here at Torrance Memorial, we are seeing more lung cancer cases. And the majority of our lung cancer detections are Stage 1 or 2. Treating lung cancer early is critically important in preventing local recurrence. Cytalux is extremely effective at picking up very small, very early cancers of the lung. The visual aid helps me surgically control and eradicate cancer in those very early stages.”

The addition of this targeted imaging agent to Torrance Memorial’s surgical toolkit comes as the improved lung cancer screening protocols are leading to more early-stage lung cancer diagnoses and an increase in cases exhibiting a particular type of tumor, Dr. Fuller says. “It’s less dense—more spread out than solid and tight. We’re seeing more of this type of tumor, mostly in women with no history of smoking, possibly because the improved screening program leads to more early diagnoses.”

A cancer nodule is illuminated thanks to Cytalux, a compound combining a form of folate (vitamin B9) with a marker dye. The folate binds to cancer cells, and the marker dye fluoresces when illuminated with a near-infrared light, making it easy for surgeons to spot them during surgery.

Cytalux can be especially beneficial in these cases. “Cytalux is not used in every case but most often used for cancer nodules that are less than 2 cm in size, and for those more diffuse nodules.”

The ability to see the cancer’s boundaries allows surgeons to dramatically decrease the amount of lung they need to remove to be sure they’ve gotten it all. “For instance, in Diane’s case I could literally mark right on the surface of the lung right where I wanted to separate it from the rest of the lung while preserving the majority of the upper lobe,” Dr. Fuller says. “This new tool helps us shift from removing an entire lobe to about one-third of the lobe.”

The extra efficiency it brings to the procedure also means patients need less general anesthesia and may be able to recover from the surgery more quickly. In Booth’s case, that meant being able to leave the hospital just days after surgery. She was able to return to work in about a month.

“We are the landmark institution on the West Coast for this procedure,” Dr. Fuller notes. “The is the kind of advance that saves lives.”