Lung Cancer Treatment

Specific treatment for lung cancer will be determined by your physician based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Lung cancer may be treated with surgery, chemotherapy or other medications, radiation therapy, photodynamic therapy, laser therapy, or a combination of treatments. Combination treatment or multimodality treatment refers to having more than one type of treatment.

Treatment for lung cancer includes one or more of the following:

  • Surgery
    Surgery may be the only required treatment, or is in some cases part of the treatment, for early stage lung cancers. The type of surgery depends on the size and location of the tumor in the lung, the extent of the cancer, the general health of the patient, and other factors. Some surgeries are done with a long incision in the side of the chest, known as a thoracotomy. The earliest stage tumors may be treated with video assisted thoracic surgery (VATS), which uses several small incisions without rib spreading (instead of one large one with rib spreading) and special long surgical tools. Types of Surgery include:

    • Segmental or wedge resection – removal of only a small part of the lung
    • Lobectomy – removal of an entire lobe of the lung
    • Sleeve lobectomy – removal of tumor without removing lung
    • Pneumonectomy – removal of an entire lung
    • Sleeve resection – removal of a piece of bronchus, after which the lung is reattached to the remaining part of the bronchus

Any of these procedures, except sleeve resection, may, in certain cases, be able to be performed thoracoscopically (by VATS).

  • Radiation therapy
    Radiation therapy is the use of high-energy radiation to kill cancer cells and to shrink tumors. Radiation may also be used with chemotherapy to treat lung cancer. There are several ways to deliver radiation, including:

    • External beam radiotherapy, which uses x-rays from a machine outside the patient’s body to kill cancer cells:
      • Intensity Modulated Radiation Therapy (IMRT)– an advanced form of three-dimensional conformal radiation (3DCRT) that reduces the dose of radiation received by healthy tissue, and allows doctors to deliver radiation to difficult-to-reach areas. A “fourth dimension” of tumor movement can be incorporated in a procedure called 4DCR for more advanced tumors confined to the chest.
      • Respiratory gated radiation therapy- enables doctors to precisely delivery radiation to the lungs by compensating for the movement that occurs when you breathe.
    • Stereotactive Ablative Body Radiotherapy (SABR)
    • Local radiotherapy, which may include:
      • Brachytherapy – the placement of radioactive materials at the tumor site to deliver more targeted radiation therapy and make treatment more convenient.
      • Radiofrequency ablation – an advanced, minimally invasive procedure that uses a heat-generating, electrode-tipped catheter to destroy tumor cells.
    • Bronchial stenting – opens up airways and makes breathing easier. A silicone or expanding stent can be placed to help the breathing in patients with lung cancer that is blocking the airway, but which cannot be removed entirely. This is frequently combined with laser ablation of the tumor that is blocking the airway.
    • Chemotherapy – The use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. Your oncologist will recommend a treatment plan based on your individual case. Chemotherapy may be given before other treatments, after other treatments, or alone for lung cancer.
    • Targeted therapy – As cancers grow, they form new blood vessels which nourish them. Research aimed at blocking the growth of these blood vessels has led to the development of medications called antiangiogenesis medications. Bevacizumab (Avastin®) is one of these medications. It has been found to be helpful in prolonging the survival of patients with advanced lung cancer. It is used with the standard chemotherapy regimen. Medications with other specific targets, such as erlotinib (Tarceva®) and cetuximab (Erbitux®), may also be useful. Another medicine called crizotinib (Xalkori®) was recently approved by the FDA for lung tumors that carry the specific ALK mutation.

There are specific names for the order in which treatment is given. Neoadjuvant 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.

Chemotherapy or radiation soon after surgery is called adjuvant treatment. The goal of adjuvant treatment is to kill any cancer cells that may be left after the surgery. Even if there is no sign of cancer cells, your physician may suggest adjuvant treatment, as it lowers the risk that the cancer may come back or spread.