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.