Experts from Texas Children's Fetal Center published a study that appears in volume 46, issue 2 of the Journal of Pediatric Surgery documenting the first successful cases of open fetal surgery to treat fetal lung malformations in the Southern U.S. The study also provides improved data to diagnose, assess, predict risk, and recommend treatment for fetal lung lesions.
Lung tumors are infrequent and difficult to treat in unborn babies, and until recently, open fetal surgery in these cases has rarely been successful. Joining the ranks of Children's Hospital of Philadelphia (CHOP) and University of California San Francisco (UCSF), Texas Children's Hospital documented successful cases of open fetal surgery for lung masses in hydropic fetuses during this study, an achievement that confirms the potential for more lives to be saved in-utero.
"Our documentation of open fetal surgery results is particularly noteworthy, and I'm proud of all the work that was done by our Fetal Center team in order to publish this manuscript," said Darrell Cass, M.D., corresponding author on the study, co-director of Texas Children's Fetal Center and associate professor, departments of Surgery, Pediatrics and Obstetrics and Gynecology at Baylor College of Medicine. "Thanks to advancements in fetal medicine, what was previously a grim diagnosis is now operable and there is hope for these babies to lead a healthy life."
The study also improved the method used to assess fetal lung lesions and determine the best candidates for open fetal surgery. A formula known as congenital cystic adenomatoid malformation-volume-ratio (CVR) was previously developed at CHOP and has since been used by a few centers to evaluate patients. The formula correlates prenatal diagnostic features with fetal and postnatal outcomes. However, up until this point, there was little data validating its use in other centers. By reviewing a relatively large series of fetuses with lung masses, Texas Children's Fetal Center was able to refine the use of CVR, and refine the precise cutoff point for identifying high-risk patients.
"This paper gives us, as a medical community, a better understanding of CVR and helps us to re-think the way we use it to predict outcomes," said Dr. Cass.
Future patients in fetal centers across the country will now be properly evaluated by using CVR and the new cutoff point that Texas Children's Hospital experts have established. Since the risks and chance of success will be determined ahead of time, doctors will know whether open fetal surgery is an optimal choice, and more lives can potentially be saved with these techniques.
The study was conducted by Darrell L. Cass, M.D.; Oluyinka O. Olutoye, M.D.; Christopher I. Cassady, M.D.; Kenneth J. Moise, M.D., Anthony Johnson, D.O.; Ramesha Papanna, M.D.; David A. Lazar, M.D.; Nancy A. Ayres, M.D.; and Bella Belleza-Bascon, R.N., and was based on 82 fetuses evaluated for lung masses at Texas Children's Fetal Center between July 2001 and May 2010. It is the most comprehensive evaluation of CVR to-date.
The complete study, called "Prenatal diagnosis and outcome of fetal lung masses" can be found in the February edition of the Journal of Pediatric Surgery.