Treatment for lung and thoracic cancers at Mass General

Lung Cancer Treatment Program

The Center for Thoracic Cancers offers patients and families access to one of New England's most experienced programs for lung cancer.
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Overview

At the Center for Thoracic Cancers, our multidisciplinary team of lung cancer specialists put together a comprehensive treatment plan just for you. Many lung patients benefit from our approach. You will see lung cancer specialists from medical oncology, radiation oncology and surgery. We:

  • Offer a collaborative approach to lung cancer diagnosis and treatment
  • Provide care and support tailored to each patient’s needs
  • Combine clinical expertise, cutting-edge research and medical technologies to offer patients the most appropriate therapies
  • Ensure patients fully understand their diagnosis and treatment options
  • View patients and their family and friends involved in their care as team members

Patients are usually seen within one week of referral.

Innovative Approaches

The Center for Thoracic Cancers is among the first in the nation to provide new targeted therapies for non-small cell lung cancer. Consistently ranked as one of the best in the country by U.S. News & World Report, we provide the promising new therapies and innovative approaches to clinical care, including:

  • Expertise in minimally invasive surgery for lung cancer, including lung-sparing techniques
  • Genotyping (molecular fingerprinting) to determine which lung cancers carry genetic mutations that might be treated with targeted therapies
  • Rapid diagnosis and staging of all biopsied tumors by pathologists who specialize in lung cancer
  • Groundbreaking research regarding the molecular basis of some lung cancers
  • The Francis Burr Northeast Proton Therapy Center, New England’s only proton radiation facility
  • Access to one of New England’s only Advanced Endoscopy Services

Expertise in Diagnosing and Staging Lung Cancer

All members of our team of pathologists and radiologists are nationally recognized for their expertise. Our pathologists participate in weekly tumor board meetings, sharing information about each patient’s unique cancer with the entire team to help guide care planning. Our radiologists use the most advanced imaging tools to diagnose and stage thoracic cancers and to detect changes in tumors. Our imaging methods include:

  • Chest radiograph
  • Computed tomography scan (CT or CAT scan)
  • MRI
  • PET and nuclear medicine scans

Our minimally invasive image-guided procedures for diagnosis include:

    • Percutaneous needle biopsy and molecular diagnostic tests
    • Esophageal ultrasound
    • Navigation bronchoscopy for biopsy of peripheral lung nodules

Advancing Medical Oncology

Some new cancer drugs currently available or in development are designed to block some of the mutations that cause tumors to grow. By targeting tumor gene mutations with these “smart drugs”, our doctors are beginning to understand how to destroy cancer cells in some patients' tumors without traditional chemotherapy and radiation.

We are among a select few centers in the world to offer comprehensive genotyping of thoracic cancers as part of our pathological assessment. Genotyping allows us to test each tumor for certain genetic mutations, which can reveal weaknesses in an individual’s cancer. We can exploit these weaknesses using targeted therapies. Understanding genetics of a tumor helps us choose the most effective treatment for a patient’s cancer.

Genotyping: Entering a New Era Treating Lung Cancer Care

We are among a select few health care institutions in the world to offer comprehensive genotyping of thoracic cancers as a routine component of our pathological assessment. This genotyping allows us to test each tumor for certain genetic mutations. These genetic markers indicate certain weaknesses in an individual’s cancer; weaknesses that we can exploit using targeted therapies. By understanding the genetics behind each lung tumor we are able to choose the specific type of treatment that will be most effective for that particular patient’s cancer. Learn more about genotyping.

 

Excellence in Surgical Care

Our team of dedicated surgeons treats some of the most challenging and complex cases from across the US. We focus only on thoracic surgery and have pioneered many now-standard procedures used to treat thoracic cancers. The team provides state-of-the-art evaluation, treatment and post-surgical services, including:

  • Chest and airway reconstruction
  • Laser surgery
  • Minimally invasive video-assisted thorascopic surgery
  • Resection of tumors in the chest wall, lungs and mediastinum
  • Lung-sparing techniques for benign and malignant neoplasms of the lung
  • Resection of tumors obstructing a bronchus or in the trachea

We offer many minimally invasive surgical procedures, such as:

  • Bronchoscopy to explore the bronchial passages
  • Navigation bronchoscopy to biopsy peripheral lung nodules or placement of radiosurgical markers to enhance tracking of the lung tumors during radiation treatment
  • Esophagoscopy to sample lymph nodes around the airway or lung
  • Mediastinoscopy to explore the area between the lungs and nearby lymph nodes
  • Thoracoscopy to explore the thorax
  • Esophageal endoscopic ultrasound
  • Endobronchial ultrasound

Pioneering Radiation Therapy Programs

Specialists in the Thoracic Radiation Oncology Program employ high-precision radiation therapy to treat patients with lung cancers and other cancers in the chest with the overarching goal of causing little or no side effects. Pioneering technological advances for the benefit of our patients include:

  • Intensity-modulated radiation therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) for reducing side effects and improving tumor kill
  • Stereotactic Body Radiation Therapy (SBRT) for the treatment of early stage lung cancers and increasingly also metastatic cancers
  • 4-dimensional (4D) CT scanning and respiratory gating for treatment of lung tumors that move around with breathing
  • Proton beam therapy in patients with certain lung cancers

Our radiation oncologists are part of a highly specialized multidisciplinary team that closely coordinates the care of each patient. Cutting-edge research aims at increasing the efficacy and reducing the side effects of radiation therapy as well as integrating radiation with revolutionizing biological drug therapies.

For more information, please see the Thoracic Radiation Oncology Program.

 

Meet the Team

Our team approach ensures that every patient benefits from a personalized, coordinated and compassionate treatment plan that includes leading experts across many specialties.

Members of your care team meet regularly with you and contact your referring physician on an ongoing basis to ensure clear communication and a seamless coordination of care.

Directors:

See the complete team list treating Lung Cancer

Patient Education

Information About Lung Cancer

Cancer that begins in any part of the lungs is called lung cancer. The two basic types of lung cancer are non-small cell lung cancer and small cell lung cancer. There is also a third type of lung cancer that is very rare, called mesothelioma.

The American Cancer Society estimated that about 234,030 new cases of lung cancer (both non-small cell and small cell) would be diagnosed in the United States in 2018. It is important to remember that great strides have been made in our understanding of lung cancer. Ways to treat lung cancer have advanced even from just a few years ago.

Diagnosing Lung Cancer

The first step in diagnosing any disease is to complete a medical history and physical exam. In order to diagnose lung cancer, your doctor may also order tests and procedures such as:

  • X-rays: These images can show any mass or spot on the lungs that might be cancer.
  • Computed tomography (CT) scan: A series of X-ray images of inside the body are combined to produce cross-sectional views of the lung. This test can show a tumor along with its spread elsewhere in the body.
  • Positron Emission Tomography (PET) scan: A PET scan uses a special dye that allows doctors to see how the body tissues are working and what they look like. This test can show whether a tumor has spread elsewhere in the body.
  • Magnetic Resonance Imaging (MRI) scan: An MRI scan uses strong magnetic fields and radio waves to capture detailed images of organs and tissues in the body. MRIs are very useful for imaging the brain and spinal cord.
  • Biopsy: A small sample of tissue or fluid is removed from the lung. A pathologist then views it under a microscope to check for cancer. Biopsies are vital for obtain cancerous tissue for genetic testing. A biopsy may be done by methods such as:
  • Fine needle aspiration biopsy: A thin, hollow needle is used to remove tissue or fluid from the lung
  • Thoracentesis: A hollow needle is inserted into the chest wall to remove fluid
  • Bronchoscopy: A flexible tube called a bronchoscope is passed down through the nose or mouth and into the bronchi to remove tissue
  • Mediastinoscopy and thoracoscopy: With both of these procedures, a thin, tube-shaped instrument is inserted into the chest to obtain tissue or lymph node samples.

Staging Lung Cancer

These tests and procedures can also help your doctor determine the stage of lung cancer. Staging is a way of describing how much the cancer has grown, how big it is and whether it has spread to other parts of the body. Staging is important because it helps your doctor plan your treatment and determine your outlook (prognosis). Lung cancer has 4 stages, numbered from 1 to 4.

  • Stage 1 means that the cancer is relatively small and contained within the lung.
  • Stages 2 and 3 mean that the cancer is larger than stages 1 and 2 and may have spread into lymph nodes and surrounding tissues close to the tumor.
  • Stage 4 means that the cancer has spread to the lung lining, the opposite lung, or another body organ. This is also called metastatic cancer.

Treating Lung Cancer

If you are diagnosed with lung cancer, your care team will work with you to develop a treatment plan that is right for you. This plan will depend on the type and stage of your cancer, your general health, and your treatment preferences.

Lung Surgery

Lung cancer surgery may involve removal of a tumor and some nearby healthy tissue, part of a bronchus, an entire lobe (section) of a lung or an entire lung. Chemotherapy or radiation therapy may also be used to kill any cancer cells left behind.

  • Sleeve resection: Part of a bronchus, the main airways of the lungs
  • Wedge resection: A tumor and some nearby healthy tissue
  • Lobectomy: An entire section of a lung
  • Pneumonectomy: An entire lung

Non-surgical Lung Cancer Treatments

Other common treatment options for lung cancer include the following:

  • Immunotherapy helps your immune system fight cancer. The immune system helps your body fight infections and other diseases. It is made up of white blood cells and organs and tissues that are part of the lymph system. Some types of immunotherapy are also sometimes called biologic therapy or biotherapy.
  • Chemotherapy kills cancer cells through the use of intravenous (IV) or oral drugs.
  • Targeted therapy uses drugs that attack specific parts of cancer cells, depending on if you have a genetic mutation and what type of mutation it is. These drugs work differently from standard chemotherapy drugs.
  • Radiation therapy uses high-energy radiation beams to kill or shrink a tumor while sparing healthy tissue. The radiation source can come from outside the body (external radiation therapy) or from implants inside the body (internal radiation therapy).
  • Clinical trials may provide access to new and promising therapies for lung cancer.

Learn more about Lung Cancer

 

Clinical Trials/Research

Overview of Clinical Trials

Clinical trials are research studies which are conducted to answer questions. They can test many things including new drugs, new combinations of drugs, or already approved drugs being studied to treat patients in new or different ways. They may include new drug doses or new ways (schedules) to give the drugs. Clinical trials are run under strict guidelines with specific criteria for eligibility and treatment. Their purpose is to help find out whether new cancer treatments are safe and effective or better than the standard (current) treatment.

The Mass General Hospital Thoracic Oncology Program has a very active clinical research portfolio with the latest, top-notch investigational studies covering a wide spectrum of thoracic cancer care. The ultimate goal of clinical research is to improve the outcomes for all of our patients. If you are eligible for a clinical trial, your physician will offer you the chance for participation. We will comprehensively review the logistics and purpose of the trial and also offer alternatives including the standard of care.

Find Clinical Trials for Lung Cancer

Find Targeted Therapy Trials for Lung Cancer

The Cancer Center also offers the MGH Cancer Care Equity Program, which strives to promote awareness about and access to cancer clinical trials through community outreach and education, financial assistance, and patient navigation.


Research

Watch Dr. Justin Gainor discuss immunotherapy research at Mass General Cancer Center.

Watch Dr. Alice Shaw discuss two recent studies on next-generation ALK inhibitors for ALK-positive lung cancer patients.

MGH Thoracic Oncology Program at the 2019 AACR Annual Meeting

The 2019 AACR Annual Meeting was held in Atlanta, Georgia, on March 29th through April 3rd 2019. The MGH Thoracic Oncology Program was represented in several research presentations, including the following:

  • Alice Shaw, MD, PhD, presented on “Refining Precision Medicine in Non-Small Cell Lung Cancer”. Dr. Shaw reviewed the general landscape of targeted therapies in advanced lung cancer and focused on the latest discoveries in ALK-rearranged lung cancer. Her presentation highlighted the rapid translation of basic research findings into the clinic in the form of novel therapies and combination strategies. Dr. Shaw also presented at the Meet the Expert Session on Lung Cancer Trials.
  • Justin Gainor, MD, presented on behalf of the SU2C/ACS Lung Cancer Dream Team, entitled “Identifying determinants of response to immune checkpoint blockade in non-small cell lung cancer.” In the last several years, immunotherapy has transformed the management of NSCLC, but a majority of patients do not respond to therapy. The SU2C Lung Cancer Dream Team has launched a major collaborative research effort to explore genomic, pathologic and clinical factors associated with response and resistance to checkpoint inhibitors. In this talk, Dr. Gainor summarizes the progress to date.
  • Lecia Sequist, MD, MPH, presented on “TATTON phase Ib expansion cohort: Osimertinib plus savolitinib for patients (pts) with EGFR-mutant, MET-amplified NSCLC after progression on prior first/second generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI),” and on “TATTON phase Ib expansion cohort: Osimertinib plus savolitinib for patients (pts) with EGFR-mutant, MET-amplified NSCLC after progression on prior third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI)”. To date, targeted therapy for lung cancer patients with EGFR mutations has consisted solely of monotherapy with various EGFR tyrosine kinase inhibitors (TKIs), though we have known for more than 10 years that a proportion of resistance to EGFR TKIs results from activation of the MET bypass pathway. Prior research has shown that MET amplification is a bypass pathway observed in about 5-10% of patients whose disease has progressed after treatment with first- or second-generation EGFR TKIs and in about 25% of those whose disease has progressed after treatment with third-generation EGFR TKIs. Data from the TATTON trial demonstrate for the first time the benefit of adding a MET inhibitor to an EGFR inhibitor in patients with EGFR-mutant NSCLC and with MET-driven acquired resistance. The study has shown efficacy of combination targeted therapy in a patient population for whom chemotherapy is the current primary treatment option. These clinically meaningful responses also demonstrate that as different heterogeneous resistance clones come up, they can in turn be brought under control by tailoring therapy.

    To watch Dr. Sequist’s presentation, please play the following video starting at minute 33:00.

View more research presentations

Patient Stories

These stories highlight the strength, courage, resiliency of our patients and the coordinated effort of the Thoracic Oncology team to provide the best care to our patients.

Yariv Kafri

“Training is about perseverance and setting goals. I want to give the doctors something they can recommend to their patients, just like they’ve given something to me.” Read Yariv's Story

Andy Lindsay

"We felt we were with people who knew what they’re doing and they were so kind. It was such a shining moment." Read Andy's Story

Linnea Olson

"In my particular case, I wouldn’t be alive if I didn’t come here. I have stage 4 lung cancer and my care here has been just absolutely cutting edge."
Read Linnea's Story

Allison and Rich Orpen

"Maybe I can’t cure it, but I can make it better. I can’t see giving in, I’ve got to fight." Read Allison and Rich's Story

Justin Perry

"Everyone at MGH went above and beyond and helped each and every day toward winning this wedding. They cared about me, checked in daily and treated me like family." Read Justin's Story

Jay Petri

"I was never afraid of coming here. I’ve always felt right at home. I actually enjoy coming here at this point. I have so many friends that have gone beyond the doctor-patient relationship. They are truly friends." Read Jay's Story

Greg Vrettos

"I was the first patient enrolled in the initial EGFR-targeted therapy clinical trial at Mass General. I didn’t have any hesitancy about starting a clinical trial because I had so much confidence in Mass General and in my team that I believed it had to be the best option.” Read Greg's Story

Contact & Support

Contact

If you have any questions or would like to speak with one of our doctors, please call the Center for Thoracic Cancers at 617-724-4000.

Support Us in the Fight Against Cancer

We appreciate your interest in supporting the Center for Thoracic Cancers at the Mass General Cancer Center and we invite you to join the Cancer Center community by participating in whatever way you are able.

Click here to donate directly to the Center for Thoracic Cancers. Be a Piece of the Solution was started by a Mass General Cancer Center patient family to provide direct financial support to the Thoracic Cancer Center. Click here to read more about Be a Piece of the Solution.

Honors & Awards

Thoracic Medical Oncology team the one hundred honorees

View thoracic oncology team members honored for their commitment to the fight against cancer.


Recent Awards

Dr. Piotrowska presented with the 2018 Jonathan Kraft Team Science Award

Zofia Piotrowska, MD, awarded the 2018 Jonathan Kraft Team Science Awards during the Jonathan Kraft Symposium for her research in cancer immunotherapy. The MGH team who won included Mark Cobbold, MRSC, PhD, MGH Cancer Center; Aaron Hata, MD, PhD, MGH Cancer Center; Zofia Piotrowska, MD, MGH Cancer Center; Kerry Reynolds, MD, Hematology/Oncology Unit; and Alexandra-Chloe Villani, PhD, Rheumatology, Allergy and Immunology Division.

Dr. Temel awarded the Walther Cancer Foundation Palliative and Supportive Care in Oncology Endowed Award and Lecture

Clinical Director Jennifer Temel, MD was recently presented with the Walther Cancer Foundation Palliative and Supportive Care in Oncology Endowed Award. Endowed by the Walther Cancer Foundation, this award and lecture was established to recognize a distinguished lecturer and leader with multiple, significant, and enduring contributions to palliative and supportive care in oncology through the prevention, assessment and management of cancer- and treatment-related suffering. Dr. Temel will accept her award and present a keynote lecture at the 2018 Palliative and Supportive Care in Oncology Symposium taking place November 16-17, in San Diego, California. Click here for more information. Congrats, Jennifer!

Dr. Marcoux presented with the PrIME Oncology Young Investigator Award

Nicolas Marcoux, MD, was presented with the Young Investigator Award 2018 by PrIME Oncology, recognizing his research on small cell transformation in EGFR-mutant lung cancer. Congratulations, Nick!

Dr. Lin presented with the 2018 Conquer Cancer Foundation Young Investigator Award

Jessica Lin, MD, received the Conquer Cancer Foundation/American Society of Clinical Oncology Young Investigator Award for her research on tumor heterogeneity of fusion oncogene-driven lung cancers. Congratulations, Jessica!

Dr. Sequist awarded the Stand Up to Cancer-LUNGevity Foundation – American Lung Association Lung Cancer Interception Research Award

Lecia Sequist, MD was presented with the Lung Cancer Interception Research Award from the collaboration of Stand Up to Cancer, LUNGevity, and the American Lung Association. The $2 million research award focus on lung cancer interception—catching precancerous cells and blocking them from turning into cancer cells. The goal of these interdisciplinary and multi-institutional awards studies is to find noninvasive, widely available diagnostic and early detection tools that will dramatically change outcomes for people with lung cancer. For more information, click here. Congrats, Lecia!

 

View more awards

News & Announcements

Dr. Shaw celebrates International Women’s Day with Stand Up to Cancer!
Mass General Lung Cancer Director, Alice Shaw, MD, PhD, proudly represents women in science leadership as the Stand Up to Cancer American Cancer Society Lung Cancer Dream Team Co-Leader. Watch the video to hear Dr. Shaw and Dr. Jaffee explain why it’s so important to have women in science and in leadership spaces. We are especially proud to support this mission with our large team of strong, intelligent women leaders and clinicians within the Mass General Thoracic Oncology team.

Mass General lung cancer patient wins Super Bowl tickets!
Dr. Shaw’s patient Patty Watkins wins the Chris Draft Family Foundation - Lung Cancer Survivor Superbowl Challenge, a competition for cancer survivors to raise funding for research and public awareness. Five-year cancer survivor, Patty was rewarded with two Super Bowl tickets to her hometown stadium in Atlanta! Click here to watch Patty and Chris’s CNN interview.

Former NFL player Chris Draft established this initiative to raise lung cancer awareness and increase badly needed research funding through its Campaign To Change The Face Of Lung Cancer, which is committed to shattering the misconception that lung cancer is a “smoker’s disease.” As Draft explains, “the Super Bowl Challenge gives us a unique opportunity to use the overwhelming media coverage surrounding the Super Bowl as a platform to raise critical public awareness about lung cancer on an international level. With the game as a backdrop, we can use each survivor’s story to weave a broader narrative about the state of lung cancer and the hope that now exists for those battling the disease.” Click here to learn more about the Team Draft Super Bowl challenge.

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