Treatment

	The Latest in Screening & Treatment Drs. Mark Kris, Kenneth Rosenzweig, and Raja Flores

Chemotherapy for Non-Small Cell Lung Cancer

Non-small cell lung cancer is difficult to cure with surgery alone, because cells from the lung often spread throughout the body and cannot be removed surgically. The first place to which non-small cell lung cancer spreads is the lymph nodes, which filter the fluid that drains from the lung.

For patients whose lung tumors have spread to lymph nodes inside the chest but are still treatable with surgery, Memorial-Sloan Kettering has pioneered a program of chemotherapy before surgery, called neo-adjuvant chemotherapy, which has doubled the five-year survival rate. It has also, for the first time, cured patients with some forms of lung cancer who would not have been cured by surgery alone. In some cases, the cancer has been reduced or completely eliminated with chemotherapy before the patient has even had surgery. Because of these promising results, doctors at Memorial Sloan-Kettering are now testing this approach using new chemotherapy drugs and targeted therapies, and offering this treatment to patients with large tumors that have not yet spread to the lymph nodes.

Even if the surgeon removes all visible tumor, chemotherapy given after surgery to kill any remaining cells in nearby tissues or elsewhere in the body, called adjuvant chemotherapy, may be offered to improve the survival rate. We administer adjuvant chemotherapy even when there is no detectable cancer in order to kill any microscopic cancer cells that may remain after surgery.

For patients with tumors that can be surgically removed but that are large in size or have spread to nearby lymph glands, adjuvant chemotherapy improves survival and cure rates. Since chemotherapy may be given either before or after surgery, the surgeon works closely with the medical oncologist to determine the optimal time to administer chemotherapy.

Chemotherapy for Small Cell Lung Cancer

Most patients with small cell lung cancer will receive chemotherapy at some point in their care, since that form of the disease almost always spreads beyond the lung via the bloodstream. Chemotherapy may be combined with radiation therapy to improve the chance of a cure. Doctors at Memorial Sloan-Kettering are among the leaders in the testing of new drugs for the treatment of small cell lung cancer.

Our lung cancer team is a national leader in research in antinausea drugs and techniques. Such measures help make chemotherapy more tolerable, allowing more patients to complete their course of treatment with less disruption to their daily activities.

Memorial Sloan-Kettering researchers are investigating a number of new targeted therapies, used alone and in combination with chemotherapy, to treat lung cancer and prevent its recurrence. Because these drugs work in a different way than chemotherapy, they do not cause side effects such as hair loss and nausea.

Also being studied is another new class of drugs known as signal transduction inhibitors, which work by blocking the signals that make cancer cells grow and spread. Our physicians were the first to recognize that certain subtypes of lung cancer respond best to this class of drugs. Among these drugs are angiogenesis inhibitors that disrupt the formation of new blood vessels which support the growth and spread of tumors.

For non-small cell lung cancer, Memorial Sloan-Kettering doctors are also testing a range of other new drugs, including an antifolate drug, which was developed here. Antifolate drugs interfere with a cancer cell's consumption of folic acid, which is essential for cell growth and division. Our investigators are also testing a number of new kinase inhibitors. Inhibiting kinases, enzymes that act as on/off switches for cells, can in some cases prevent the growth of new cancer cells.

Memorial Sloan-Kettering is also testing a range of other new drugs that may target tumors more effectively. Such research protocols are sometimes offered to eligible patients through the clinical trial process. For an up-to-date listing of lung cancer clinical trials at Memorial Sloan-Kettering, please visit the clinical trials section.

	Image-Guided Radiation Therapy (IGRT) Learn more about IGRT, an enhanced form of radiation used to treat cancer Runtime: 3 minutes

• Image-Guided Radiation Therapy

  The radiation oncologists at Memorial Sloan-Kettering treat approximately 400 new patients each year. Drawing on this experience, they have helped to pioneer and have extensive experience using intensity-modulated radiation therapy (IMRT) to treat lung cancer. IMRT uses sophisticated computer programs to calculate variable doses and angles of radiation to target a tumor. This procedure, also known as stereotactic body radiation therapy (SBRT), allows our radiation therapists to make the treatment field smaller so that the tumor receives higher doses of radiation from many angles while surrounding healthy tissue is spared. In standard IMRT, the patient has his or her tumor three-dimensionally "mapped" during a CT scan performed days before the first radiation treatment.

  Some patients with small early-stage lung tumors that are peripherally located -- in other words, located close to the edge of the lung -- can be treated with a specialized form of IMRT called image-guided radiation therapy (IGRT). While standard radiation therapy requires patients to undergo radiation treatment every day for six to eight weeks, IGRT allows our radiation oncologists to administer precisely targeted radiation that usually requires fewer treatments than older forms of radiation therapy. Patients receiving IGRT have their tumors mapped on the same day as their first radiation treatment, which allows for very accurate targeting. This procedure requires no anesthesia, and side effects are generally minimal. Our team performs more IGRT procedures to treat patients with lung tumors than any other center in New York.

  Memorial Sloan-Kettering also pioneered the integration of positron emission therapy (PET) imaging into the radiation treatment planning process. We have one of the only PET simulators in New York City, and one of the few in the country. Because the details of the tumor are better defined, PET simulator technology allows doctors to target tumors precisely, resulting in superior treatment plans for our patients.

• Radiofrequency Ablation

  Another minimally invasive procedure we perform is known as percutaneous ablation, which uses either heat (radiofrequency) or cold (cryoablation) to treat lung tumors. During percutaneous ablation, we use CT imaging to place a needle into the tumor, and then apply either cold or heat to destroy tumor cells. This technique requires no incisions and is useful for some patients who are not good candidates for surgery.