Issue link: https://viewer.e-digitaledition.com/i/1395101
Lobectomy — resection of a lobe of a lung — is the gold-standard treatment for lung cancer, according to Dr. McLarty, due to its ability to remove the tumor and surround- ing microscopic disease that could lead to cancer recurrence if it were to remain in the lung and enter the bloodstream or spread to the lymph nodes. For some patients, lobectomy can be performed usi ng v ideo-a ssisted t horacoscopic surgery (VATS), a minimally invasive approach. She points to the development of better staplers — used to divide lung parenchyma and blood vessels — and other specialized surgical instruments as one reason for increased use of minimally invasive techniques. "Previously, we made 12- or 15-centi- meter incisions and fractured or removed ribs to resect lung tumors, but now, we reserve that sort of large incision for siz- able tumors that might be invading large structures," Dr. McLarty says. "For rou- tine patients, we use thoracoscopy with smaller incisions and small instruments. This translates to enhanced recovery." The Lung Cancer Program benefits from being part of Stony Brook Medicine, which allows the program's clinicians to easily consult and collaborate with other specialists within the network. An example is collaboration between a lung cancer surgeon and a plastic surgeon to treat a patient with a large, resectable tumor that has grown into surrounding structures, such as the ribs and chest wall. Resecting the tumor may necessitate removal of part of the chest wall, leaving a defect. If that seems likely, the plastic surgeon plans a chest reconstruction prior to tumor resection, and then joins the lung cancer surgeon during the operation to perform the reconstruction. The Lung Cancer Program features dedicated cardiothoracic anesthesiolo- gists who assist with surgical cases and provide postoperative pain control. A diverse tea m of nurse practitioners, physician assistants, respiratory thera- pists, physica l therapists a nd others helps patients recover a nd a mbulate after surgery. MEDICAL ONCOLOGY'S CRUCIAL ROLE IN CARE The Lung Cancer Program's medica l oncologists typically meet with patients following a biopsy and diagnosis of lung cancer. These clinicians coordinate che- motherapy, radiation therapy and surgery for individuals with advanced disease, and they conduct long-term follow-up care to monitor patients for recurrences and complications of treatment. Medical oncologists oversee patients' chemotherapy and immunotherapy treat- ments — a list of options that seems to grow by the year. Stony Brook Cancer Center hematologist/oncologist Roger Keresztes, MD, who has been practicing in the field for more than two decades, ma r vels at the ongoing rise in FDA- approved medications to treat lung cancer. Dr. Keresztes gives an annual lecture to medical residents about new develop- ments in oncology, and the pace of change in the field is such that he updates the slide about FDA-approved medications for lung cancer with new additions each year. " W hen I started in oncolog y in the 1990s, there was only one FDA-approved medication for lung cancer. Now, there are dozens," he says. "We've begun test- ing every tumor for specific mutations, many of which we can treat with an oral medication with few side effects and very good response rates. We now have the capability of enhancing the immune response to tumors, and many of our patients will have good, long-lasting responses with immunotherapy drugs. There have been a number of advances in immunology that allow us to link certain medications to antibodies that can carry Radiation oncologist Mark Ashamalla, MD, who specializes in lung cancer, and Co-Director of the Center for Lung Cancer Screening and Prevention April Plant, DNP, meet with a patient. Director of Outpatient Imaging Charles Mazzarese, MPS, RT, performs a low-dose CT scan. 0 8❱❱❱❱❱ C O V E R F E A T U R E