Lung Cancer Program

The Lung Cancer Program at Allegheny General Hospital differs from most others in that it combines the clinical treatment of lung cancer with an active research program, providing experimental treatment approaches for patients for whom conventional intervention yields limited results. The program team is comprised of thoracic surgeons, medical and radiation oncologists, and pulmonologists with extensive experience in lung cancer - all of whom are part of the Allegheny Center for Lung and Thoracic Disease.

In addition, Allegheny's tradition of translational research distinguishes it from other programs in that it gives patients access to the latest treatments developed from on-site, hospital-based laboratory research - particularly in protocols generated through Drexel University College of Medicine. Through research being conducted into the ways that cancer cells can be forced to mature or die, new treatments are being created that may one day prove more effective than standard chemotherapy currently being used.

Primary areas of basic science and clinical investigation under way by the researchers of the Allegheny Center for Lung and Thoracic Disease involve the use of new chemotherapeutic and biologic agents for more advanced lung cancers and the use of less invasive diagnostic and therapeutic surgical techniques for the management of all stages of lung cancer and other chest malignancies. Specific investigation into the utility of new treatment agents such as suramin, interferon or gemcitabine are currently under way. These substances are known to work by inducing terminal squamous differentiation (maturation) and/or programmed cell death (apoptosis) in both small cell and non-small cell lung cancer. Other studies are examining the effectiveness of new chemotherapy agents, including taxanes, camptothecins and vinca alkaloids. These agents have been recently found to have promising activity against lung cancer.

The use of drugs aimed at "chemoprevention" of the development of lung cancer are also being studied by the center's cancer specialists. These studies use agents such as retinoids (Vitamin A derivatives) as cancer preventive treatments among patients at high risk for the development of lung cancer. These patient groups would primarily be those who have previously undergone resection of early stage lung cancers and heavy smokers with a previously abnormal bronchoscopic examination.

The lung cancer specialists of the center were the first in the region to study the role of combined systemic therapy (chemotherapy), surgery and radiation therapy in attempting to improve the cure rate for early stage and mildly advanced lung cancer. They continue to focus on this multi-modality approach, which aims at destroying any unrecognized microscopic cancer with chemotherapy and optimizing removal of the cancer in the chest with surgery and radiation therapy. In addition to chemotherapy, the cancer specialists are also actively involved in clinical and basic science investigations utilizing gene therapy approaches attempting to strengthen the immune system of the cancer patient and weaken the ability of tumor cells to act cancerous.

Minimally invasive surgical management of lung cancer and other thoracic malignancies is of primary interest to the thoracic surgical cancer specialists of the center. These include video-assisted, mini-surgical access (see Minimally Invasive Surgery) for resection of lung and esophageal tumors and, expanded use of endoscopic approaches to problems related to these cancers. Patients with malignant airway or esophageal obstructions are managed with the use of endoscopic dilatation, debridement/laser ablation or stent insertion to act as primary or supportive care prior to surgical treatment. These approaches often lead to an improved quality of life for the patient with lung and esophageal cancer. The pulmonologists and thoracic surgeons of the center have led the region in this area of endoscopic laser and stent therapy during the last decade. They also work closely with the center's radiation oncologists in new methods of radiotherapy such as interstitial radiation treatments at the time of surgery and endobronchial radiation (see Brachytherapy section). Other clinical activities of the center's cancer specialists involve the use of stereotactic radiosurgery to treat lung cancers that have spread to the brain.

Combining these minimally invasive diagnostic and potentially therapeutic methods - including radiologic techniques and video-assisted surgical resection - minimizes unnecessary major surgery while providing the greatest possible rates of detection and precise excision of malignant tumors.

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