Treatments We Offer
Mount Sinai physicians are skilled in providing the full range of lung cancer treatments. We develop a treatment plan tailored to your cancer and preferences. Our team of pulmonologists, thoracic surgeons, medical oncologists, and radiation oncologists works together to give you the best possible care.
We use a broad range of standard and state-of-the-art treatment options including surgery, radiation, medical oncology, including molecular targeted therapies, and immunotherapy. In addition, we offer a full range of supportive services: pain management, integrative medicine, reiki, yoga, acupuncture, social work, nutrition, and psychological support.
Research suggests that surgery to remove tumors is the most effective treatment for early-stage lung cancer. When we remove cancer cells, we also take a thin margin of health tissue around the tumor, to be sure we got everything. Under the leadership of Raja Flores, MD, Chairman for the Department of Thoracic Surgery at The Mount Sinai Hospital, we use a variety of surgical procedures. The exact approach depends on your individual situation. We offer the most advanced surgical procedures, including:
- Minimally invasive lung surgery: We remove the cancer cells of the lung by performing a lobectomy, a procedure that involves removing an entire lobe of the lung. We also biopsy the adjacent lymph nodes to show us if the cancer has spread outside the lung. If necessary, we remove the lymph nodes.
- Video-assisted thoracoscopic lobectomy (VATS): This advanced procedure involves making three small incisions and using a specially designed camera and instruments. Our surgeon can perform the entire operation from outside the chest. With VATS surgery, we remove the tumor with less pain and a faster recovery than the traditional open-chest approach. We usually use VATS surgery to remove the entire lung. We may also be able to use VATS to remove a smaller section of the lung.
Whenever possible, we use minimally invasive interventions. These procedures involve shorter recovery times, minimal scarring, and less pain than open surgery.
Radiation therapy uses high-powered energy beams or particles to target cancer cells and kill them. At Mount Sinai, we use a variety of radiation treatments including:
- Laser therapy stenting: This approach uses a high-energy laser beam to eliminate a cancer tumor. We use it most often with more advanced cancers.
- Radiofrequency ablation: This approach uses high-energy radio waves to heat the tumor. We tend to use this approach for small lung tumors located near the outer edge of the lungs.
- Stereotactic body radiation therapy: Also known as stereotactic ablative radiotherapy, this approach is used to treat early-stage lung cancers.
- Three-dimensional conformal radiation therapy: Using special computers, we map the tumor’s location. Then we aim radiation beams at the tumor from several directions.
- Brachytherapy: With this approach, we insert small pellets of radioactive material directly into the cancer or into the airway next to the cancer. After about 10-20 minutes, we remove the pellets.
Molecular Targeting Therapies and Chemotherapy
Over the last decade the therapy for lung cancer has changed dramatically with the rapid development of specific targeted therapies directed towards specific molecular abnormalities in the tumor. These therapies are mostly in the form of pills and have significantly fewer side effects compared to traditional chemotherapy.
Because of the progress with molecular targeted therapies, it is crucial to make a molecular characterization of the tumor before a treatment decision is made. Several molecular abnormalities (for example, EGFR, ALK, ROS, MET, RET, NTRAK, and KRAS mutations) can be targeted effectively with anti-cancer drugs.
Mount Sinai’s Pathology Department and special laboratories are well equipped to make a quick molecular characterization of the tumor from the patient’s tumor tissue, or based on a blood-sample assessment. The technology mostly used for this is Next Generation Sequencing (NGS), which is routinely done for all lung cancer patients at Mount Sinai at the time of primary diagnosis.
Chemotherapy is a more traditional medical oncology approach that uses anti-cancer medication. We often use combinations of two or more drugs. Some chemotherapy can be given orally; other chemotherapy is administered directly into a vein. We may use chemotherapy before or after surgery. It is especially helpful when the cancer cells have spread to other parts of the body and we cannot remove them surgically.
One of the latest approaches to medical oncology is immunotherapy. This approach uses medicine to boost the body’s immune system and stimulate it to attack cancer cells. Researchers are still learning more about this approach, but immunotherapy has demonstrated to be very promising in lung cancer with very good long-term outcomes in some patients (30-40 percent), even patients with advanced stage lung cancer. Immunotherapy is particularly relevant in case the tumor does not have a molecular abnormality that can be targeted with a drug. Doctors often use immunotherapy in conjunction with more traditional approaches.
We collaborate closely with Mount Sinai’s immunology specialists to develop more effective medical therapies that are less toxic and cause fewer side effects. We offer our patients the latest treatments current science has to offer.
We focus on understanding the disease and discovering new ways to combat it by:
- Researching new immunological treatments, including vaccines
- Studying the biology of lung cancer
- Keeping abreast of emerging therapies being developed by our colleagues
Early-stage lung cancer is treated most effectively with surgery to remove it. Mount Sinai Health System is renowned for its advancements in minimally invasive surgical procedures that allow for faster recovery times, less scarring, and less pain than open surgery. In addition, our thoracic surgery services offer innovative therapies like laser therapy stenting and radiofrequency ablation. Our expert surgeons offer the most advanced, least invasive procedures for removing lung cancer, including:
Minimally invasive lung surgery: Our surgeons remove the malignant area by performing an anatomic resection of lung called a lobectomy. In addition, they sample and remove the adjacent lymph nodes, giving them the most accurate means of identifying whether or not the cancer spread outside the lung.
Video-assisted thoracoscopic lobectomy (VATS): These leading-edge procedures include the minimally invasive procedure, video-assisted thoracoscopic lobectomy (VATS). Making only three small incisions and using a specially designed camera and instruments, the surgeon can perform the entire operation from outside the chest. VATS surgery delivers the same surgical benefit by removing the tumor with less pain and a faster recovery than the traditional open approach. In contrast to the open procedure, there is no rib spreading or need to fracture the rib to perform the operation. In some circumstances, VATS can be used for a segmentectomy, or wedge resection—two smaller resections that can also remove the cancer.
In many patients, the team of physicians may decide that your cancer is best treated with radiation therapy, either by itself, or as part of a combined treatment plan by our physicians specializing in the treatment of lung cancer in a variety of disciplines.
Innovative radiation oncology: Mount Sinai specialists are pioneering the development of innovative methods for the delivery of precise doses of radiation to lung tumors during certain points in the respiration cycle. These methods allow our team of physicians to increase the radiation dose safely, to shorten treatment, and spare healthy tissue. Radiation therapy is the use of high powered X-rays to kill cancer cells. Our Department of Radiation Oncology expert radiologists may incorporate positron emission tomography (PET) scans to differentiate more precisely the areas of cancer which must be treated, offering the most innovative procedures for treating lung cancer, including:
- Stereotactic body radiation therapy: Mount Sinai has an active program in stereotactic body radiation therapy that delivers high doses of radiation to the lung tumor. The physician and therapist review scans taken just before treatment to deliver the radiation dose accurately. Recent studies from across the world have shown that this technique can control over 90 percent of cancers treated.
- Internal radiation therapy (Brachytherapy): In certain cases, radioactive material is placed directly into or near the tumor. This internal radiation, or brachytherapy, places the radioactive material directly into the body, targeting the tumor while sparing the nearby normal organs to from most of the radiation exposure.
- Modulated radiation therapy (IMRT): We treat most patients with intensity modulated radiation therapy (IMRT), a highly advanced form of treatment, which delivers high doses of radiation precisely to the tumor while avoiding critical structures such as the lung and the esophagus.
- Radiofrequency ablation: This technology permits patients who are not surgical candidates to undergo tumor removal using an X-ray guided electrode to deliver eat to tissues
Innovative medical oncology: Mount Sinai Health System is consistently at the forefront of using and developing increasingly effective chemotherapies. Through a combination of our research clinical specialization, and personal compassion, our thoracic medical oncology specialists excel in delivering the most comprehensive and successful chemotherapy treatments. Chemotherapy after surgery can significantly improve survival in cases of non-small cell lung cancer when cancer cells from lungs often spread to other parts of body and cannot be removed surgically.
We are developing new medical therapies for cancer that are less toxic, causing fewer side effects while being more effective than existing medications. Our goal is to ensure that we are offering our patients the latest treatments current science has to offer. We focus on understanding the disease and discovering new ways to combat it by:
- Researching immunological treatments such as vaccines
- Keeping abreast of the emerging therapies being developed by others
- Studying the biology of lung cancer itself
We now have a new class of medications, molecular targeted therapy, which works by blocking the signals that make cancer cells grow and spread. This new generation of medications includes anti-angiogenic agents such as:
- Bevacizumab (Avastin). Avastin is given in combination with chemotherapy, and has improved survival in patients with advanced lung cancer.
- Oral inhibitors of the epidermal growth factor receptor (EGFR). Oral inhibitors include gefitinib (Iressa), and erlotinib (Tarceva).