Lung Cancer: Treatment

At NewYork-Presbyterian/Columbia lung cancer patients are treated by a multidisciplinary team of doctors including a radiation oncologist, a medical oncologist and a surgeon, who provide highly coordinated, comprehensive care.  

Non-small cell lung cancer may be treated first with surgery, to remove the initial tumor.  This treatment may be followed by radiation therapy or chemotherapy.  These therapies may be given either alone or in combination.

Small cell lung cancer is often treated with chemotherapy and radiation therapy, given the same time or one immediately following the other.

There are specific terms referring to the order of treatment.

  • Neo-adjuvant treatment refers to having radiation or chemotherapy before surgery. Having one or both of these before surgery may help shrink the tumor - a smaller tumor is easier to take out in surgery.
  • Adjuvant treatment refers to chemotherapy or radiation given right after surgery. The goal is to kill any cancer cells that may be left in the body. Even if there is no sign of cancer cells, your physician may suggest adjuvant treatment, as it lowers the risk that the cancer may return or spread to other organs.

Surgery

Surgery may provide the best chance of a cure for early stage non-small cell lung cancer.

To qualify for surgery, a patient must pass pulmonary function tests.  These will determine whether there will be enough healthy lung tissue left after surgery.  A physician may also order tests to check the function of the heart and other organs, and insure that the patient is in good enough health to undergo an operation.

The type of surgery will depend upon the size and location of the tumor, and how well the patient’s lungs are functioning.  

All surgeries require general anesthesia and normally involve a surgical incision between the ribs in the side of the chest (called a thoracotomy).

Surgery is usually not performed on patients with advanced stage lung cancer.  

A physician may recommend one of these surgical procedures, depending upon the nature of the cancer and the general health of the patient.

  • Pneumonectomy, removing the entire lung
  • Lobectomy, removing an entire section (lobe) of a lung
  • Segmentectomy, or wedge resection, removing a portion of a lobe
  • A Sleeve Resection, removing some cancers lodged in the large airways of the lungs.  
  • During these operations, the nearby lymph nodes are generally removed to check if the cancer has spread beyond the lung.

Patients with more healthy lung tissue tend to do better with more extensive surgery.   Removing a larger portion of the lung generally provides a greater chance of a cure.

More information, can be found here

Chemotherapy

Chemotherapy limits the cancer cell’s ability to grow or reproduce. Chemotherapy for lung cancer may be given alone, before other treatments, or in combination with other treatments.

For patients with advanced non-small cell lung cancer (NSCLC), the use of chemotherapy has become routine. Our experts employ the latest and most effective drugs such as Gemzar®, Navelbine®, Taxol®, and Taxotere®. The challenge is to find the best combination and sequence of these drugs, and this emerging science is actively under study.

Patients with NSCLC that has spread to lymph nodes in the chest, but who are still recommended for surgery, benefit from chemotherapy given prior to surgery. The role of chemotherapy, using the many new drugs now available, following complete surgery in less advanced disease is currently under analysis. Your NewYork-Presbyterian/Columbia medical oncologist will advise you on all the latest findings that may affect your treatment.

Novel Drugs

Iressa is a novel drug that blocks a certain type of growth factor (EGF) associated with the spread of cancer, but it only works in certain patients.

Others may receive a similar medication, erlotinib (Tarceva®) or pemetrexed (Alimta®), a drug that blocks enzymes needed for growth by the cancer cells.

Targeted Therapy

As cancers grow, they form new blood vessels that nourish and sustain them.  Targeted therapies have been developed to block the growth of these blood vessels.  These drugs are medications called anti-angiogenesis medications. Bevacizumab (Avastin®) has proven effective in patients with advanced lung cancer, when used with the standard chemotherapy regimen.

Photodynamic Therapy

Photodynamic Therapy (PDT) involves injecting photosensitizing chemicals into the bloodstream. These chemicals have a longer-lasting effect on cancer cells, than they do on healthy cells. Once the healthy cells have eliminated this chemical, a laser can be focused directly on the tumor, destroying the cancer cells. The laser or light source, is delivered through a bronchoscope (a small, flexible tube) inserted through the mouth or nose.

Radiation Therapy

With advanced radiation therapy techniques doctors can better target tumors while reducing the radiation to nearby healthy tissues. Here at HICCC our radiation oncology experts have the ability to provide “state of the art” treatments for lung disease.

Your radiation oncologist will design the optimal treatment plan for you with you that will provide you the best optimal results. Treatment delivery can be daily, weekly, every other day, and or single fraction.

If radiation treatment is recommended, a radiation oncologist will work with our radiation oncology team to create a course of treatment. At Columbia University Irving Medical Center treatment modalities available and most commonly used for this cancer are External Beam Radiation Therapy, 3D Conformal Radiotherapy, Intensity Modulated Radiation Therapy (IMRT), Image Guided Radiation Therapy, Stereotactic Body Radiation Therapy (SBRT), Brachytherapy, Intraoperative Radiation Therapy (IORT) and Gamma Knife.