The Departments of Radiation Oncology works together with medical oncologists and thoracic surgeons to provide patients with the most comprehensive multidisciplinary management of lung cancer. The most current and effective treatment approaches are provided in ultramodern settings where patient privacy and comfort are foremost.
There are two main types of radiation treatments, external and internal, that can be used based on the needs of the patient. External beam radiation is delivered using a linear accelerator that produces high energy x-ray or electron beams that are aimed at the diseased tissues. Internal radiation or brachytherapy uses radioactive seeds placed within or next to the area to be treated.
External beam radiation is the most common form of radiotherapy. It uses a linear accelerator to aim a beam of radiation at the diseased tissue. Each treatment lasts a few minutes and is administered over a number of weeks, five days a week. There is no discomfort during the actual radiation treatment. Radiotherapy hardware, software, treatment planning and delivery methods have advanced dramatically in recent years. These advances allow us to more accurately target the cancer with higher doses of radiation, while minimizing damage to adjacent healthy tissue. NewYork-Presbyterian utilizes the following state-of-the-art treatment techniques during our external beam lung treatments as required by the individual needs of each patient.
3D-CRT techniques are also frequently used to ensure that all the parts of each tumor are completely treated in all 3 dimensions. It combines multiple radiation treatment fields to deliver very precise doses of radiation to the lung and to spare the surrounding normal tissue.
At NewYork Presbyterian we use IMRT to treat lung cancer because of its ability to precisely vary or modulate the intensity of the radiation beam to match the shape of the tumor. This very accurate method assures that the entire tumor is properly treated and the exposure to normal tissue is minimized. The minimal exposure of normal tissues minimizes unwanted side effects. The treatment is given 5 days a week for 7 to 8 weeks.
Since the lungs are in continuous motion from breathing, it is a challenge to assure that the tumor does not move outside of the treatment field. At NewYork-Presbyterian, we use 4D treatment planning methods that take this motion into account. 4D is a relatively new planning method that may result in better outcomes.
During SBRT, each patient is gently and comfortably placed in frame with special measuring devices that allow the treatment team to exactly locate the area to be treated in relation to the frame. Later, the patient is treated using that same frame to guide pencil thin beams of radiation to target the diseased area in continuous arcs. This very precise treatment is given once or twice a week for 3 to 6 weeks.
At NewYork-Presbyterian, we often use technology that combines or "fuses together" magnetic resonance images (MRI), positron emission tomography (PET), and CAT Scan images to help us determine the geometric and metabolic characteristics of each tumor. This process allows for better treatment planning and maximizing the benefit of IMRT.
NewYork-Presbyterian Radiation Oncology is one of a few centers in the country to offer intraoperative seed implants for lung cancers. During this procedure, radioactive seeds are placed in diseased tissue during an operation to remove a lung tumor. They may be placed in areas where it is difficult or impossible to achieve complete surgical removal of all the diseased tissue or in patients for whom a more aggressive surgery may be considered too risky. The seeds give off their radiation over the next weeks and months to treat any remaining disease. For this purpose, we continue to use Iodine-125 (I-125) seeds and most recently, NewYork-Presbyterian was one of the first in the nation to use a new isotope called Cesium-131 (Cs-131). Cs-131 gives off its radiation in a shorter time period and has some other beneficial characteristics that may improve outcomes.
During HDR treatments, a tiny highly radioactive source is computer guided through a catheter to the area of the lung to be treated. It is left in place for a few minutes to deliver a therapeutic dose of radiation and then removed. There is little or no discomfort. This type of HDR treatment is often used to treat cancers near or within the bronchial tubes of the lung including metastases from other parts of the body. Patients who need additional radiation but cannot get additional conventional radiation because of prior treatment, may also benefit from this type of therapy.