About Treatments at MedStar Washington Cancer Institute:
The MedStar Washington Cancer Institute offers a range of treatments depending on your needs. We based our recommendations on:
- The type of lung cancer
- The cancer’s stage: the tumor’s size, whether it is one lung or two and whether it has spread
- Whether the cancer has mutations in certain genes
- Your overall health
Radiation therapy uses high-energy X-rays or other radiation to kill cancer cells or stop them from growing. Some examples of when we use radiation for lung cancer treatments include:
- After surgery to prevent cancer from returning
- With chemotherapy
- By itself—either to treat tumors when patients can’t or don’t want to have surgery or to relieve late-stage disease symptoms
- Before surgery, to shrink a tumor
- To the brain, to make sure small cell lung cancer does not spread there after otherwise successful treatment
We offer the latest, safest radiation treatments, including 4D computed tomography (CT) and respiratory gating to adjust for tumor movement and CyberKnife for delivering therapy with laser-like precision. Initial results from our clinical trial show that CyberKnife is as effective as surgery for treating early-stage, non-small cell cancer—good news for patients too frail or ill for an operation.
Types of Radiation Lung Cancer Treatment
We use two types of radiation therapy, depending on the type of lung cancer and its stage:
- External Radiation: A machine outside the body sends radiation to the cancer. Types of external radiation we use include:
- 3D Conformal Radiotherapy (3D-CRT): Radiation beams are sculpted to a tumor’s particular shape — useful when they are irregular or are close to healthy tissues and organs. We view the tumor in 3D, then deliver radiation from several directions.
- Intensity-Modulated Radiation Therapy (IMRT): Our radiation oncologists can change treatment intensity as they go based on tissue type, delivering specific doses to different parts of a tumor and sparing healthy tissue.
- Image-Guided Radiation Therapy (IGRT): Our team incorporates high-quality imaging throughout the period from diagnosis to treatment, adjusting for tumors that may shift and allowing for tighter margins and fewer side effects.
- Internal Radiation: Treatment is delivered through a radioactive substance that is sealed in needles, seeds, wires, or catheters and placed in or near the cancer.
CyberKnife for Lung Cancer
CyberKnife is an advanced form of external radiation sometimes called radiosurgery, though it does not involve surgery. It uses image-guidance systems and a robot arm rotating around your body to:
- Deliver hundreds of tiny radiation beams at various angles, with sub-millimeter precision
- Track and adjust for tumor motion while you breathe, minimizing the harm to surrounding areas and delivering a higher dose of radiation straight to the cancer
- Reduce the number of lung cancer treatment sessions
CyberKnife is particularly useful for inoperable or hard to reach tumors, and is especially successful at treating lung cancer. We were one of the first teams in the country to adopt CyberKnife and remain among the most experienced.
CyberKnife and Early-Stage Lung Cancer Study
Even when non-small cell lung cancer was caught early, doctors in the past couldn’t always use the best treatment — surgery. That left radiation, which was a less-than-ideal choice because of possible side effects and restrictions on giving higher, more effective doses.
But the safety, precision and potency of CyberKnife could change that — as tentatively demonstrated by a clinical trial run by the head of our thoracic CyberKnife program. He’s giving CyberKnife radiation to patients with early-stage cancer who are not candidates for surgery, and initial results are showing that the outcomes are just as good.
This could provide an alternative to surgery for patients who have an inoperable early-stage tumor, are too old or sick for an operation or simply don’t want to undergo one.
4D Computed Tomography and Gating
A problem for most external radiation systems is that lung tumors often move when you breathe—interfering imaging tests and forcing radiation oncologists to expand the treatment area so no cancer is missed. While holding your breath can help, many lung patients can’t do so for very long and the effort doesn’t guarantee accuracy.
We use our sophisticated 4D computerized tomography (CT) scanner before lung cancer treatment, to take images of the tumor throughout your breathing cycle. Sometimes, it turns out the tumor doesn’t move much. But in many cases, our team uses the scans to determine the best point in your breathing cycle (gating) to deliver treatment, providing more refined therapy and sparing healthy lung tissue.
Chemotherapy for lung cancer uses drugs that are injected into a vein or swallowed to enter the bloodstream and kill cancerous cells throughout the body.
Chemotherapy is the main lung cancer treatment for small cell lung cancer, using a combination of drugs and possible paired with radiation. For non-small cell lung cancer, our chemotherapy uses include:
- Before surgery (neoadjuvant) to shrink a tumor
- After surgery (adjuvant) to kill any remaining cancer cells
- As the main treatment (with radiation) for inoperable cancer or for people who aren’t healthy enough for surgery or don’t want to undergo it
- With a targeted therapy to control later-stage disease
We continue to study the best combination of chemotherapy drugs. We also offer genetic testing of tumors, to determine when we should try a newer targeted therapy first.
Surgery is rarely the main treatment for small cell lung cancer—fewer than 5 percent of patients are good candidates, meaning the cancer is confined to one lung and has not spread to lymph nodes. But it offers the best chance of curing early-stage, non-small cell lung cancer and is often used with chemotherapy or radiation for more advanced disease.
Lung surgeries are complex operations with potentially serious consequences, so they are best handled by experience thoracic surgeons like ours. We use the latest research and technology to diagnose and treat patients, and offer a full range of procedures—including minimally invasive surgery or interventional pulmonology for some cancers.
Minimally Invasive Surgery
A newer technique called video-assisted thoracic surgery (VATS) allows our doctors to make smaller incisions in the chest than the traditional, open approach (thoracotomy), meaning:
- Less post-operative pain
- Shorter hospital stay
- Faster recovery
- Fewer complications
During the procedure, our surgeons insert a thin tube (thoracoscope) with a camera and use the images on their monitor for guidance as they remove the tumor with special instruments.
VATS is a complex procedure, and our surgeons have the technical skills needed for success. For now, it is typically only recommended for smaller tumors near the outside of the lung, and for patients with limited lung capacity who can’t lose any more tissue.
Lung surgeries that are not performed with a minimally invasive procedure require a thoracotomy—giving the patient anesthesia, making an incision in the chest and then cutting and spreading the ribs for access. From there, the type of surgery depends on the tumor’s size and location and how well your lungs are functioning—if you can spare more tissue, this provides a better chance that any traces of the disease surrounding the tumor are eliminated.
- Wedge Resection removes a tumor and some of the normal tissue around it (called a segmental resection when a slightly larger amount of tissue is taken)
- Lobectomy removes a whole lobe of the lung
- Pneumonectomy removes a whole lung
- Sleeve Resection removes part of the bronchus, one of the main passageways into the lungs
Lung Cancer Treatments and Interventional Pulmonology
Sometimes doctors find abnormal cells in the airway that could turn into non-small cell lung cancer but have not yet done so. Doctors trained in the newer field of interventional pulmonology can treat this condition by inserting a special tube (endoscope) down your nose or mouth, then delivering:
- Laser kills the cells with a laser beam
- Photodynamic Therapy places an anti-cancer drug, then activates it with light
- Cryosurgery freezes and destroys the cells
- Electrocautery kills the cells with electric current
Targeted therapy represents a new front in attacking cancer. It involves drugs and other substances aimed at specific molecules that help tumors grow, progress, and spread. The idea is to target a tumor’s unique characteristics, including genes, proteins, or host tissue, while limiting damage to healthy cells.
Targeted therapies often cause fewer side effects than current lung cancer treatments and may replace or complement them. We are studying new ways to analyze individual tumors and target specific features.
We offer several types of targeted therapies, many of them in clinical trials:
- Growth Factor Inhibitors target certain surface molecules—growth factor receptors—on cancer cells that help them grow.
- Monoclonal Antibodies mimic immune system proteins to deliver toxins or radioactive substances directly to cancerous cells.
- Small-Molecule Tyrosine Kinase Inhibitors block signals that tumors need to grow.
- Checkpoint Inhibitors release the normal brakes on the body’s immune system.
- Cancer Vaccines are designed to treat, not prevent, cancer by boosting the immune system’s response
- Drugs that target ALK Mutations target mutations of the ALK gene that may help non-small cell lung cancer to grow and spread.
Lung Cancer Palliative Care
Palliative care is the branch of medicine that helps patients alleviate their pain and discomfort during a long or chronic illness. Our lung cancer patients often have challenges with breathing. Helping patients breathe more easily and go about their daily lives is an essential part of what our lung cancer team considers a priority.
Managing pain and helping lung cancer patients maintain and build their ability to perform daily activities through pulmonary rehabilitation is a large part of palliative medicine, as are spiritual, social and psychosocial support services.
Our Palliative Care includes: