CHICAGO — Laura Rotunno didn’t think she had much longer to live.

“My body has had enough,” Rotunno, of Deerfield, remembered thinking last year, under the weight of Stage 4 lung cancer. The color had drained from her face, she was on oxygen and it was difficult to leave her home.

That all changed, however, after May 30 of last year, when she received a double lung transplant at Northwestern Medicine. When she awoke from the surgery, she didn’t have an oxygen tube for the first time in months.

“I couldn’t believe it,” Rotunno, 64, said. “It’s just surreal to still be here.”

Rotunno was one of the subjects of a new study that Northwestern doctors hope will be a game changer when it comes to transplants for people with advanced lung cancer.

Hospitals don’t typically perform lung transplants on people with advanced lung cancer, partly over concerns that the cancer will recur after the transplant, leaving the patient no better off, said Dr. Ankit Bharat, a co-corresponding author of the study, which was published in the peer-reviewed journal JAMA on Wednesday. Patients who receive new organs must take medication to suppress their immune systems, which can lead to a recurrence if any cancer cells are left in the body.

But over the last several years, Northwestern has performed lung transplants on 17 patients with terminal lung cancer whose cancer was confined to their lungs and for whom other treatments didn’t work. All 17 patients either survived for at least one year after their transplants or were still alive at the conclusion of the study.

“Their survival is typically in days or weeks,” Bharat said of patients with Stage 4 lung cancer, “but now we are offering a dramatically different option which really can dramatically improve their life and offer a possibility of more long-term disease control.”

By comparison, about 88% of Northwestern lung transplant patients who did not have lung cancer survived to the one-year mark after the surgery, according to the study. Patients who had Stage 4 lung cancer but who couldn’t receive transplants, for various reasons, had a far lower rate of survival.

When removing the patient’s lungs, Northwestern surgeons work carefully to avoid spilling cancer cells into the chest cavity or blood stream — drawing on lessons learned from performing lung transplants on patients with COVID-19 during the pandemic. After removing the lungs, they wash the chest cavity and airways to clear any remaining cancer before putting in the new lungs.

Bharat emphasizes that lung transplants aren’t for every patient with lung cancer. They’re for patients who have exhausted other treatments for cancer and whose cancer hasn’t spread beyond their lungs, he said.

“The transplant is not meant to replace any existing cancer treatments that are available,” said Bharat, who is chief of thoracic surgery and executive director of Northwestern’s Canning Thoracic Institute. “It’s meant to add another line of treatment when everything else has failed.”

Bharat also noted that the transplant isn’t a cure-all for everyone.

Of the 17 patients who underwent transplants, two died after the study period ended from complications unrelated to cancer, Bharat said. Also, four of the patients saw their cancer come back, but Bharat said the recurrences were more manageable than the original disease.

“We absolutely expect that we’re going to have recurrences,” Bharat said. “The patients still do so much better with both quality and longevity, and even when the recurrences happen it’s easier to manage those.”

Bharat hopes the study inspires more large transplant centers to perform the procedure on patients with advanced lung cancer — so those patients have more options closer to home.

Jodi Graf, a robotics software developer for NASA, traveled from Texas last year for her lung transplant at Northwestern.

Graf had been ill for decades before the transplant, at first, with unexplained shortness of breath. For years, she was misdiagnosed with other conditions before doctors discovered she had interstitial lung disease, which causes scarring of the lungs, making it difficult to breathe.

Still, she was stable for 10 to 15 years before her health began to decline around 2020.

While undergoing testing for a lung transplant, doctors found cancer in her lung. Because of her condition, she couldn’t undergo chemotherapy or surgery for the cancer, so she had radiation treatments — but they weren’t enough. It was understood, she said, that she was dying.

Graf, however, had seen an article online about Northwestern’s program. She got in touch with Northwestern, and from that point, things moved quickly.

In November of last year, Graf and her husband traveled to Northwestern for a biopsy to see if her cancer had spread outside her lungs. It had not, and she was put on the list for donor lungs.

A day later, she got the call that there was a match.

Graf was frightened but excited. Graf, her husband and two sons had been avid hikers, visiting national parks across the country. By the time she was called for a transplant at Northwestern, it had become difficult to leave her house even with portable oxygen.

“You have this opening up of your life possibilities,” said Graf, 61, of learning she would get a transplant. “Suddenly, I’m thinking of hiking in the Rocky Mountains instead of sitting in my room with an oxygen tank.”

Since her surgery on Thanksgiving Day, Graf and her husband have been living in Chicago, just blocks from Northwestern. They plan to stay until the one-year anniversary of her surgery, so she can be close to the hospital for follow ups and care.

For now, they’ve been enjoying Chicago — seeing the cherry blossoms in Jackson Park, exploring the neighborhoods and walking along the lakefront.

But she’s also, for the first time in years, dreaming of the future.

“I really probably can hike in the Rocky Mountains,” Graf said, “maybe not the higher ones, but at least some of the lower ones.”

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