Our team of medical, surgical, and radiation oncologists, pathologists, and radiologists — all specialized lung cancer experts — work together to determine the right choices for your individual treatment. Treatment is based not only on diagnosis and stage, but also on the genetic profile of your tumor and may include surgery, chemotherapy, radiation therapy, or any combination of all three. You will also have access to an array of support programs and services.
Collaboration is the key to success. Our surgeons, medical oncologists, radiation oncologists, radiologists and pathologists are lung cancer experts working together in a unique, collaborative model that focuses exclusively on the diagnosis and treatment of lung cancer. Our staff members meet daily as a group to evaluate the most effective options for each patient.
For patients with early stage cancer (stages 1 and 2), surgery is almost always a first step (although in some cases radiation can replace surgery — see Radiation Oncology section below, for more details). Our surgeons will often remove tumors with minimally-invasive techniques, and determine an ideal course of treatment based on careful analysis of the tumor itself.
Surgery removes cancer and in many cases, may be the only treatment needed. In some cases, chemotherapy and/or radiation therapy will be recommended following surgery to minimize the risk of recurrence.
In addition to standard chemotherapy options, our medical oncology team is utilizing targeted treatments with lower toxicity. These have proven to be highly effective medications for particular types of non-small cell lung cancer.
For patients with locally advanced (stage 3) cancer, treatment usually begins with chemotherapy and radiation therapy. Frequently, these treatments are given at the same time. Surgery is often an option after this initial treatment.
For patients with metastatic (stage 4) cancer, surgery is not always an option. When cancer has spread, surgery might remove one part of your cancer, but it cannot treat the entire disease. Chemotherapy and radiation therapy, however, can treat cancer when it has spread. Patients with stages 3 and 4 non-small cell lung cancer may begin (or are treated entirely) with chemotherapy and radiation therapy.
Surgery
Our thoracic surgeons have pioneered the use of new surgical techniques, and continue to develop innovative approaches to achieving the best outcomes for lung cancer patients. Dana-Farber Brigham Cancer Center is home to one of the few dedicated thoracic surgery intensive care units in the country, with sub-specialized nursing staff and state-of-the-art healthcare resources.
Types of Surgery
Dr. Scott Swanson is Director of the Minimally Invasive Thoracic Surgery Program at Brigham and Women’s Hospital, and Chief Surgical Officer and Thoracic Oncology Disease Center Leader.
Minimally invasive surgery: Our lung cancer surgeons are highly experienced and skilled in minimally invasive techniques and robotic procedures. Many patients come to us after learning they are not candidates for surgery, and we are able to provide surgical treatment that is safe and effective. Minimally invasive surgery involves the use of several small incisions, 5-10 mm in length. These incisions provide access for surgical instruments and a video camera, which are manipulated outside the body by the surgeon while viewing the entire operation on a video monitor in the operating room. The goals of minimally invasive surgery are to:
Improve accuracy and visualization
Minimize trauma to tissue
Decrease pain
Shorten the time to return to work and activity
Limit scarring
Decrease the chance of complications and mortality associated with surgery
Open-chest surgery: Open procedures are becoming less common, as we find that minimally invasive surgeries are easier on the patient and equally effective. Nevertheless, there are situations in which major surgery is required, such as when the tumor is deep inside the lung.
Medical Oncology
Our medical oncologists are international leaders in developing targeted treatments for specific types of non-small cell lung cancer, based on the genetic make-up of the tumor, such as those carrying mutations in EGFR (originally discovered at Dana-Farber Brigham Cancer Center nearly ten years ago) and ALK genes. Clinical trials of new targeted therapies are now underway, targeting recently discovered genetic abnormalities such as BRAF mutations and RET mutations.
Personalized Medical Oncology
Our medical oncologists have pioneered the use of genomic analysis of biopsy specimens to understand what drives the biology of an individual cancer, and guide the selection of targeted therapies. They can then use this knowledge to design and develop treatments that focus on the specific weaknesses of each patient's tumor. Promising treatments include oral "targeted" drugs or specific clinical trials matched to the tumor's weak points. Our novel treatments include new drug combinations aimed at overcoming resistance to targeted therapies.
Chemotherapy
Medical oncologists administer chemotherapy, a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Our oncologists use their extensive expertise to determine the right care plan for each patient.
Chemotherapy may be used before surgery if your tumor is too large or complex for immediate surgery. In this case, you may also receive radiation therapy to supplement medical treatment. Chemotherapy may also be used after surgery to minimize the risk of recurrence.
When lung cancer has metastasized outside of the chest, chemotherapy is used to reduce the cancer and its symptoms. It is also used to help a patient live as long as possible with their cancer.
Throughout your treatment, our multidisciplinary team, which also includes nurses, nutritionists, social workers, palliative care specialists and others, will work to ensure that any toxicities and side effects from chemotherapy are minimized so that you can live fully and comfortably with a good quality of life.
Clinicians and researchers (from left) Dr. Pasi Jänne, Dr. Kwok-Kin Wong, and Dr. Nathaneal Gray study new ways to treat drug-resistant non-small cell lung cancer.
Clinical Trials
Clinical trials are part of the cancer research process. Clinical trials explore if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. We are also working hard to understand the basic biology of this disease to develop more effective treatments.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.
We have an active clinical trial program exploring new anti-cancer treatment strategies including oral therapies and immune-modulating therapies. You can learn more about clinical trials for lung cancer at Dana-Farber Brigham Cancer Center, and ask your clinician if a trial is right for you.
Radiation therapy is a non-invasive form of cancer treatment that uses various forms of radiation to kill cancer cells. Radiation therapy may be used at several points during treatment to reduce and treat tumors, and to manage symptoms. Our thoracic radiation oncologists specialize in radiation therapy techniques that effectively target lung cancer cells while maximally sparing healthy tissue.
In some cases of stage 1 cancer, when surgery is undesirable, radiation therapy can also cure the disease. (See stereotactic body radiation therapy, below.) After a few outpatient treatments, the tumor is eradicated.
In some cases, radiation is used to reduce a large or complex tumor, so that a previously inoperable tumor becomes operable.
Radiation therapy is also sometimes used post-operatively to eliminate any possible remaining cancer cells.
Using new tools, it is possible to design radiation treatment in such a way that injury to surrounding tissues is minimized. When appropriate, radiation oncologists also use a system called respiratory gating to ensure that the cancer is properly targeted as the patient breathes and the lungs move.
In some cases, patients experience symptoms such as shortness of breath or pain that is caused by their cancer. In such cases, or in advanced lung cancer, radiation therapy can effectively reduce a mass, relieving symptoms and improving quality of life.
Our radiation oncologists evaluate the location, type, and stage of your tumor to determine the most effective form of radiation therapy for your situation. Your treatment may include:
Image-guided radiation therapy (IGRT) involves daily imaging to ensure the tumor is centered within the radiation beams for each treatment.
Intensity-modulated radiation therapy (IMRT) involves sophisticated computerized planning techniques to maximize delivery of radiation to the tumor while sparing nearby healthy tissues.
Stereotactic ablative radiation (SABR), also known as stereotactic body radiation therapy (SBRT), uses precise patient positioning and image-guided radiation to deliver sufficiently high doses of radiation to destroy tumors in as few as three to five treatments. This is most appropriate for stage 1 and other isolated tumors in the periphery of the lung.
Patients requiring surgery for lung cancer are cared for by a dedicated team of thoracic specialists who are part of our specialized surgical oncology team. Our medical, nursing, and support staff all have special expertise in working with patients with these cancers — providing treatment and assisting each patient through a medically and emotionally challenging time.
Surgery takes place in the operating rooms at Brigham and Women's Hospital, whose lung cancer surgery program is recognized widely as one of the best in the country. Post-surgical care and other inpatient care are provided by Dana-Farber and Brigham and Women's Hospital.
Most of our outpatient care takes place at Dana-Farber Cancer Institute. Infusion therapy is provided at the new Yawkey Center for Cancer Care, one of the most advanced outpatient centers in the country, designed with the input of patients and families to meet their specific needs.
Symptom Management
At the Lowe Center for Thoracic Oncology, our specialists work exclusively with patients who are coping with lung cancer and related diagnoses. Our multidisciplinary team includes program nurses, infusion (chemotherapy) nurses, nutritionists, social workers and others to help you to live fully while receiving treatment.
If you have questions or concerns during the day, our triage nurse can answer your questions. If you have symptoms or medical issues during non-office hours, a nurse practitioner will answer your questions or help you connect with your doctor. Other support services available through our Center include:
Management of symptoms and side effects. Our palliative care specialists will work with your doctors to provide treatment.
Help with non-emergency concerns. Our on-call nursing staff can provide you with help in managing issues, such as skin rashes (common with lung cancer treatment) and shortness of breath.
Help in finding wigs, hats, and other items. Friends' Place boutique helps you cope with hair loss and other treatment side effects.
Recovery of strength and stamina. Our on-call nurses will help you to set up appropriate and convenient post-treatment occupational or physical therapy, as well as integrative therapies to ease stress and fatigue.
Home care services. We can help you set up your home with oxygen, skilled nursing, or, if appropriate, hospice care.
Non-Small Cell Lung Cancer Support Services and Follow-Up Care
Patients diagnosed with lung cancer have a great deal to manage, from emotional distress to practical issues, such as handling insurance paperwork, finding lodging, and connecting with valet parking services. Dana-Farber Brigham Cancer Center can help you navigate through your cancer journey.
Dana-Farber Brigham Cancer Center provides a wide range of support programs, resources and survivorship care for our patients with lung cancer. These programs and resources can help you and your family address issues that you may face as a result of your cancer, or its treatment. Below are some of our selected programs and services.
Counseling and Social Work
Our licensed social workers are here to help adult patients and their loved ones face the many new concerns and anxieties following a cancer diagnosis, offering emotional support and assistance with obtaining needed resources.
Zakim Center for Integrative Therapies
Integrative therapies, also known as complementary therapies, range from acupuncture and massage to nutritional guidance and music therapy. Patients treated at the Zakim Center credit its services with easing nausea, improving circulation, and reducing pain, stress, and anxiety associated with cancer treatment.
Nutrition Consultation
Our nutritionists are registered dietitians who can assist you in planning an optimal diet during any stage of your cancer journey, coping with any side effects you may experience, and answering your questions about the latest findings on cancer and nutrition.
Spiritual Care
Through all stages of cancer treatment and survivorship, our Spiritual Care staff is available 24 hours a day to provide emotional and spiritual support for patients and their family members.
Follow-up services are provided through Dana-Farber Cancer Institute's Adult Survivorship Program, a member of the LIVESTRONG Survivorship Center of Excellence Network. The Adult Survivorship Program provides clinical care and services for adult-onset cancer survivors, including research that focuses on finding solutions to key problems adult survivors may face after cancer treatment.
Our physicians, nurses, researchers, and psychologists are experts in survivorship, and will work with you and your primary care physician to create a plan for living well beyond cancer.
Our diagnostic team provides second opinions, including for challenging or difficult cases. We are happy to consult with you, your primary care physician, or other specialists. Consider a second opinion for:
Because you, the referring physician, are an integral part of your patient's care team, we are committed to collaborating with you to provide the best care for your patient.
