Tracheal Regeneration Project:
This is one of our primary projects in which we are working to create a bioengineered
trachea for patients in need of substantial tracheal reconstruction. Such reconstructions
can be necessary for patients with traumatic injury, tumor ingrowth, or stenosis
of the trachea. Currently, there is no adequate alternative and if successful we
aim to provide lifesaving or palliative treatment.
In order to achieve our goals, we have employed the principles of tissue engineering
and associated techniques. We are currently working with a novel collagen scaffold,
bioreactor and stem cells, and have thus far observed promising early results. In
addition to this, we are exploring the realm of 3-D printing and the benefits it
may provide in tracheal regeneration. As the field of medicine continues to rapidly
evolve, our group aims to remain at the forefront of these revolutionary technologies
in order to provide the best patient care possible.
Radiation sensitivity in lung cancer cells:
Radiation therapy (RT) is increasingly becoming an integral component in the management
of NSCLC. However, patients with NSCLC exhibit a wide-spectrum of response to RT
both in vitro and in vivo. A reasonable percentage of stage I patients go on to
develop loco-regional recurrence and the survival rate still remains less than 25%
in patients with locally advanced disease. Hence, there is a gap in our knowledge
as to why certain patients respond better to RT compared to others. Over the past
decade, molecular genotyping and genomic sequencing has significantly contributed
to our understanding of molecular mechanisms underlying NSCLC. The discovery of
various driver events in adenocarcinomas has led to the development of various targeted
therapies. Molecular genotyping is becoming a routine practice to guide clinical
care in patients with lung adenocarcinoma.
Patients with lung adenocarcinoma frequently harbor oncogenic mutations in EGFR,
KRAS, BRAF, PIK3CA, ERBB2, ALK, ROS1 and MAP2K1 genes. Very recently, comprehensive
genomic characterization of squamous cell cancers has identified recurrent somatic
mutations in FGFR, CDKN2A PIK3CA, BRAF and NOTCH1. Usually, the mutations are mutually
exclusive, determine distinct underlying biology and are associated with differential
sensitivity to various therapies.
We believe that these mutations can serve as effective biomarkers to help tailor
RT according to individual cases.
A major concern for patients with lung cancer is the development of central airway
obstruction due to tumor ingrowth or external compression of the central airways.
We closely follow the outcomes of this cohort, and thus far have been able to show
that patients have a substantially longer survival following early intervention.
Other ongoing projects:
In addition to these main projects, we also invest much time into other aspects
of thoracic surgery / thoracic oncology. Active areas of interest includes outcomes
research of tracheoplasty for patients with Wegener’s granulomatosis, lymph node
assessment / staging for lung cancer surgery with EBUS, effects of herbs when used
as a chemotherapeutic agent, HIV associated lung cancer, as well as cost analysis
and outcomes of robotic thoracic surgery.