Treatment

Lung Cancer Treatment

There are different types of lung cancer treatments depending on the type and stage of the cancer and the person’s overall health. For each type of lung cancer (small-cell, non-small cell and recurrent), there are both standard treatments, such as surgery, radiotherapy, chemotherapy and clinical trials. At Siteman, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer. That’s why careful diagnosis is so important.

As part of a research medical center, physicians at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis have access to a wide range of clinical trials to test new therapies as they emerge. Many of our physicians are principle investigators in these trials that aim to improve medical, surgical and radiation therapies. Discuss with your physician how your cancer therapy might benefit from participation in clinical trials.

The major treatments for lung cancer include surgery or radiation to treat local tumors and chemotherapy to treat the whole body, especially cells that have spread. Clinical trials are testing many other approaches, some of which are becoming standard of care for lung cancer treatment.

Non-Small Cell Lung Cancer

Surgery

Surgeons may remove lung tissue based on the extent of the cancer. A wedge resection is the smallest, taking only the tumor and a clear margin around it. A lobectomy is used to remove one lobe of a lung where the cancer is larger or centrally located. A pneumonectomy removes a whole lung. Specialized techniques such as sleeve resection and segmentectomy are aimed at removing the lung tumor but sparing as much lung tissue as possible.

Siteman Cancer Center’s dedicated chest surgery units sees more patients than many others in the country. They remove an entire lung only when absolutely necessary. Instead, they are adept at the sleeve resection in which cancer in the main bronchus (or air tube) is removed and the ends reconnected to salvage healthy parts of the lung, which saves more lung tissue and preserves normal function. Anesthesiologists who assist the surgeons specialize in heart and chest surgical anesthesia. A full-time pain management team monitors and manages post-operative discomfort.

Our surgeons are adept at video-assisted thoracoscopic surgery (VATS), a type of thoracic surgery performed using a small video camera that is put into the patient’s chest using a scope. The camera and instruments are inserted through separate small holes in the chest wall, greatly reducing the chance for infection and healing problems from a large incision. Many lung cancer procedures are done this way.

Radiation Therapy

Each new patient’s case is presented at a multidisciplinary conference to personalize his or her treatment. This conference includes specialists in surgery, radiation oncology, chemotherapy and pathology to take into account specific tumor characteristics. Radiation oncology has active trials for minimizing the duration and amount of radiation a patient receives to reduce long-term side effects. The goal of the radiotherapy trials is that no one should be over or under treated. Siteman is a leader in using shorter durations of radiation treatment for lung cancer than the national average with the same, or better, outcomes.

The goal of radiation treatment  for lung cancer is to eliminate or shrink a tumor, either alone or in combination with surgery and/or chemotherapy. It can be delivered as external radiation beams from outside the body, or internally, with the radiation source implanted in the tumor. Sometimes radiation is given to control a tumor that can’t be cured in order to increase the patient’s comfort.

Siteman fine-tunes the radiation planning with intensity modulated therapy using a CT scan simulator for 3D planning to precisely target therapy. Siteman radiation oncologists were the first in the world to have the ability to do external radiation with MRI guidance, and the first to treat patients with that technology. They have taken the lead in four-dimensional conformal radiation therapy that allows for tumor movement during breathing.

In early-stage, non-small cell lung cancer, stereotactic radiation can pinpoint a specific single target as effectively as surgery. For patients not healthy enough for surgery, this is a good option.

  • Proton Beam Therapy: The S. Lee Kling Proton Therapy Center at the Siteman Cancer Center is the only proton therapy center located in Missouri and the surrounding region. It houses the world’s first compact proton beam accelerator. Radiation oncologists and physicists here helped evaluate the system and developed the patient protocols and quality standards for this advanced technology.

Proton beam therapy’s main advantage is that radiation specialists can control radiation beams by depth, shape and the amount of radiation given. In other external radiation therapies, radiation beams pass through a patient to a defined location and then exit the body on the other side, leaving deposits of radiation all along their path. Because proton therapy allows for depth control, the majority of radiation is held until the beam hits the precise area targeted, and little to no radiation is delivered past the tumor. This treatment is ideal for patients with solid tumors that are located near sensitive structures or tissues, such as the heart. Proton therapy can be used as a solo treatment option for localized lung cancer, or it can be used in combination with other radiation therapies or chemotherapy.

Chemotherapy

Chemotherapy involves the administration of drugs, either orally or intravenously to kill cancer cells. Recently, several new drugs have increased the options for physicians treating patients with lung cancer. Therapy that falls under medical treatment has a wide range of approaches, including timing of treatment. It can be given before or after surgery, in conjunction with radiation or by itself.

Chemoradiation: This treatment combines chemotherapy and radiation to increase the effects of both, and is used often in treatment. Medical and radiation oncologists work as a team to deliver the treatment with increased efficiency.

Targeted therapy: This type of treatment uses drugs or other substances that attack specific cancer cells and do less harm to normal cells than standard chemotherapy or radiation.  Targeted therapy can include monoclonal antibodies given intravenously or small-molecule tyrosine kinase inhibitors given by mouth.

Immunotherapy: Drugs targeting certain inhibitors rev up the immune system to attack the lung cancer and restore anti-tumor immune response.

In addition to standard therapy, clinical trials are available and may be recommended.

Small-Cell Lung Cancers

Rarely, very small tumors may be amenable to surgical removal. Usually patients with this lung cancer are treated with chemotherapy, and radiation is added to the chest for patients with limited stage disease. Patients who have good response to initial chemotherapy may receive preventive brain radiation. Small cell is resistant to treatment. Clinical trials are recommended.

Different combinations of therapies may be used depending on the stage of the cancer and grade of the cancer cells. New combinations of therapies are always being tested in clinical trials and are available at Siteman Cancer Center before other places may have access to them.